Traditional and Non-Conventional Medicine. a Multi Contextual Approach - PAOLO ROBERTI Di SARSINA...

ENTE MORALE

ENTE MORALE

Traditional and Non-Conventional Medicine: a Multi Contextual Approach

Paolo Roberti di Sarsina, MD

Expert for Non Conventional Medicine, High Council of Health, Ministry of Health, Italy

Observatory and Methods for Health, University of Milano-Bicocca, Italy

Integrative Medicine Workshop - Barcelona 10-12.01.2014

Integrative Medicine Conference

Mental disorders and dementia

Organizers: Tibetan Medicine School of the International Shang Shung Institut and the Dzogchen Community in Spain

Location: Casal del Médico (Via Laietana, 31, Barcelona, Spain) Dates

10,11 and 12 January 2014

Cost: Languages: Webcast:

125 € (with discounts for students, people with low income and members of the IDC) English / Spanish (with simultaneous translation) http://www.shangshunginstitute.net/webcast/video.php

Program

Friday 10 January Introduction to the Integrative Medicine 16.00h-16.30h Moderator Eloisa Álvarez Centeno

16.30h-17.30h

Prof. Chögyal Namkhai Norbu

Total Integration: Beyond the Relative Health Condition

17.30h-18.00h Dr. Phuntsog Wagmo

Meeting Point between Eastern and Western Medicines

18.00-18.30h Coffee break

18.30-19.00h Dr. Paolo Roberti di

Sarsina Traditional and Non-Conventional Medicine: a Multi contextual Approach

19.00h-19.45h

Pepa Ninou and Dr. Imma Nogues

Healthcare in the National Plan of Values

19.45h-20.15h

Round table

Saturday 11 January

Mental disorders 10h-10.15h

Moderator

Dr. Eva Juan Linares

10.15h-10.45h

Psychiatry (AM)

To confirm

Psychiatry and Mental Disorders

Fondata il 1 Dicembre 2007 Iscri6a nell’Anagrafe Unica delle Onlus nel Se6ore di A?vità di Assistenza Sociale e Socio-‐Sanitaria

Iscri6a nel Registro delle Persone Giuridiche

-‐ Memorandum of Understanding with and Member of The European AssociaMon for PredicMve, PrevenMve and Personalised Medicine -‐ EPMA -‐ Memorandum of Understanding with the Horst-‐Goertz-‐InsMtute for the Theory, History and Ethics of Chinese Life Sciences, Charité-‐Medical University Berlin, Germany

-‐  Interdisciplinary MulMtask PAin CooperaMve Tutorial Pain Relief OrganisaMonal AcMvity Enhancement -‐ IMPACT -‐  Componente della Campagna di Farmacovigilanza per l’Età Pediatrica “Giù le Mani dai Bambini”

-‐ Forum del Terzo Se6ore della Provincia di Bologna -‐ Libere Forme AssociaMve del Comune di Bologna

Sede Legale Via San Vitale 40/3a -‐ 40125 Bologna

www.medicinacentratasullapersona.org [email protected]

20/05/13 07:28Associazione per la Medicina Centrata sulla Persona ONLUS

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SOCI ONORARI

CHÖGYAL NAMKHAI NORBU (2010) HARALD WALACH (2011)

PETER ZIMMERMANN (2012) THOMAS BREITKREUZ (2012)

PAUL U. UNSCHULD (2013)

SCIENTIFIC ADVISOR

HARALD WALACH

Associazione per la Medicina Centrata sulla Personain collaborazione con

Istituto Internazionale Shang Shung per gli Studi Tibetani

Lezione Magistrale del Prof. Namkhai Norbu:“La Medicina Tibetana: patrimonio dell’Umanità”

Bologna, sabato 11 settembre 2010, ore 9Aula Magna, Istituto di Anatomia Umana Normale,

Università di Bologna, via Irnerio 48

Patrocinii:

Segreteria Scientifica: Paolo Roberti di Sarsina, Luigi Ottaviani, Alfredo VannacciSegreteria Organizzativa: Paolo Roberti di Sarsina, Nadia Gaggioli, Luigi Ottaviani, Cesare Pilati

Associazione per la Medicina Centrata sulla Personawww.medicinacentratasullapersona.org [email protected]

Sua Santità il XIV Dalai Lama

Presidenza del Consiglio dei Ministri

Ministero degli Affari Esteri

Regione Emilia-Romagna

Provincia di Bologna

Comune di Bologna

Facoltà di Medicina e Chirurgia, Università di Firenze

Istituto Italiano per l’Africa e l’Oriente, Roma

European Medical Association

European Association for Predictive, Preventive and Personalised Medicine

Ordine Provinciale dei Medici-Chirurghi e degli Odontoiatri di Bologna

Osservatorio e Metodi per la Salute, Università degli Studi di Milano - Bicocca

Azienda Unità Sanitaria Locale di Bologna

Fondazione di Noopolis, Roma

L’ASSOCIAZIONE PER LA MEDICINA CENTRATA SULLA PERSONA

Fondata nel 2007, l’Associazione per la Medicina Centrata sulla Persona ha come fine la tutela della salute della popolazione, l’umanizzazione, la personalizzazione e la sostenibilità dei trattamenti basan-dosi sulla centralità del paziente nella scelta delle cure. L’Associazione tutela, salvaguarda, promuove, studia, tramanda e applica il patrimonio culturale dei saperi e dei sistemi medici antropologici sia occidentali sia orientali, nel rispetto dell’integrità originaria e tradizionale dei singoli paradigmi e lignaggi.L’Associazione intende promuovere e sostenere iniziative finalizzate al progresso degli studi e delle ricerche nei vari campi di intervento della medicina centrata sulla persona.

Chögyal Namkhai Norbu Rinpoche

Chögyal Namkhai Norbu nasce a Derge, nel Tibet orientale, nel 1938. Da bambino viene riconosciuto come reincarnazione (tulku) del grande Maestro di Dzogchen Adzom Drugpa (1842-1924) e successivamente S.S. il XVI Karmapa, lo riconosce come la reincarnazione (tulku) di Shabdrung Ngawang Namgyal (1594-1651), primo Dharmaraja del Bhutan. Ancora adoles-cente completa il rigoroso percorso di studi tradizionale, ricevendo insegnamenti da alcuni dei più grandi maestri dell’epoca. Nel 1955 incontra Changchub Dorje (1826-1961), il suo princi-

pale maestro (Maestro Radice) di Dzogchen, il cui stile di vita e modo di insegnare lo ispireranno profondamente.Nel 1960, in seguito alla drammatica situazione sociale e politica in Tibet, riesce a trasferirsi in Italia accettando l’invito del prof. Giuseppe Tucci, fondatore dell’Orientalistica in Italia, fondatore dell’Istituto Italiano per il Medio ed Estremo Oriente (IsMEO), ora Istituto per l’Africa e l’Oriente (IsIAO), contribuendo così a dare un impulso concreto alla diffusione della cultura tibetana in Occidente. Nei primi anni sessanta lavora a Roma all’IsMEO, e, in seguito, fino al 1992, insegna Lingua e Lettera-tura Tibetana e Mongola all’Istituto Universitario Orientale di Napoli. I suoi lavori accademici denotano una profonda conoscenza della civiltà tibetana, e una tenace volontà di mantenere vivo e facilmente accessibile lo straordinario patrimonio culturale del Tibet. Alla metà degli anni settanta, dopo avere insegnato per alcuni anni Yantra Yoga a Napoli, Chögyal Namkhai Norbu incomincia a dare insegnamenti Dzogchen, incontrando un crescente interesse dapprima in Italia e poi in tutto l’Occidente. Nel 1981 fonda la prima sede della Comunità Dzogchen di Merigar ad Arcidosso, in Toscana. Nel corso degli anni migliaia di persone diventano membri della Comunità Dzogchen in tutto il mondo. Sorgono centri negli Stati Uniti, in varie parti d’Europa, in America Latina, in Russia e in Australia. Nel 1988 Chögyal Namkhai Norbu fonda ASIA (Associazione per la Solidarietà Internazionale in Asia), un’organizzazione non governativa impegnata soprattutto in progetti educativi e medico-sanitari rivolti alla popolazione tibetana.Nel 1989 Chögyal Namkhai Norbu fonda l’Istituto Shang Shung con il compito di salvaguardare la cultura tibetana promuovendone la conoscenza e la diffusione e ASIA Onlus.Ancora oggi Chögyal Namkhai Norbu viaggia costantemente in tutto il mondo tenendo conferenze e ritiri cui partecipano migliaia di persone.Glottologo, ricercatore di fama mondiale della Civiltà dello Shang Shung e della Tradizione Tibetana, profondo conoscitore della Medicina Tibetana, il prof. Namkhai Norbu ha scritto centinaia di testi.

L’Istituto Internazionale Shang Shung per gli Studi Tibetani

L’Istituto Internazionale Shang Shung è stato fondato nel 1989 da Chögyal Namkhai Norbu Rinpoche e inaugurato nel 1990 a Merigar da Sua Santità il XIV Dalai Lama. È un ente culturale senza fini politici o di lucro, la cui missione è quella di preservare la cultura tibetana nella sua purezza ed integrità.

Prende il nome dall’antico regno dello Shang Shung, che prosperava in quelle vaste regioni più di 4.000 anni fa ed è considerato l'origine della cultura del Tibet.La straordinaria cultura tibetana, sopravvissuta per migliaia di anni pura e incontaminata, trasmessa di generazi-one in generazione, rappresenta uno dei tesori del nostro pianeta.Oggi esiste il concreto pericolo che questo tesoro unico possa andare perduto. Pertanto, l’Istituto Shang Shung promuove la conoscenza della cultura tibetana in tutti i suoi aspetti – religiosi, filosofici, artistici, storici, sociali – al fine di salvaguardarla e contribuire alla sua conservazione.L’Istituto organizza corsi, seminari di studio, conferenze, mostre; cura la traduzione pubblicazione di numerosi libri e testi; vanta un moderno centro di documentazione multimediale; offre borse di studio a giovani tibetani meritevoli. La sede centrale dell’Istituto Shang Shung è a Merigar (Arcidosso, Grosseto); altre sedi sono presenti in Austria e negli USA. Negli anni l’Istituto ha collaborato con diverse Università, Fondazioni e Musei, contribuendo ad accrescere l’interesse per la cultura tibetana in tutto il mondo. Nel 2005 L’Istituto ha istituito il primo corso tradizionale di Medicina Tibetana in occidente, riconosciuto dall'Universita' di Xining (il piu' importante centro di Medicina Tradizionale Tibetana al mondo) e da ATMA (American Tibetan Medicine Association)

ASIA Onlus, Associazione per la Solidarietà in Asia Organizzazione Non Governativa di Cooperazione Internazionale (Decreto Ministero degli Esteri)

ASIA è nata in seguito ad una serie di missioni condotte in India e Nepal (nel 1978) e in Tibet (nel 1981 e nel 1988) dal prof. Namkhai Norbu insieme ad un gruppo di studenti, che rimasero fortemente colpiti dalle difficili condizioni in cui vivevano i tibetani e dal forte declino della lingua

e della cultura tradizionale conseguente alla rivoluzione culturale cinese.Con lo scopo di salvaguardare la Cultura Tibetana e di sostenere lo sviluppo economico, sociale e culturale sia dei Tibetani rimasti in Cina che di quelli profughi in India e Nepal, nel 1988 il professore e suoi studenti fondarono ASIA – Associazione per la Solidarietà Internazionale in Asia. Fino al 1992 il lavoro di ASIA si è focalizzato sugli insediamenti tibetani in India allo scopo di migliorare le condizioni di vita dei rifugiati; in seguito l’attenzione si è rivolta sempre di più verso il Tibet etnico, nelle aree della Cina abitate dalla minoranza tibetana (Qinghai, Sichuan, TAR, Gansu).Nel 1993 è stato presentato al Ministero degli Affari Esteri un primo progetto di intervento multisettoriale volto a promuovere l’educazione, la salute, l’autosufficienza economica dei nomadi e la protezione artistico culturale nel villaggio di Gamthog, nella Prefettura di Chamdo (Regione Autonoma Tibetana).Nel 1997 è stata inaugurata la prima scuola costruita da ASIA: una scuola tibetana elementare e media nel villaggio di Dongche – nella provincia del Qinghai, nell’Amdo.Nel 1999 è arrivato il riconoscimento di idoneità da parte del Ministero degli Affari Esteri come ONG di Cooper-azione Internazionale.Nel 2001 ASIA ha firmato il “partnership agreeement” con ECHO (l’Ufficio per gli Aiuti Umanitari della Comu-nità Europea) per i progetti di emergenza e dal 2005 è presente con progetti di post-emergenza anche in altri paese del continente asiatico.

Casa Editrice Shang Shung

La Shang Shung Edizioni, fondata in Italia nel 1983, cura la stampa dei testi degli insegnamenti di Chögyal Namkhai Norbu e di altri Maestri rappresentativi della spiritualità e della cultura buddhista tibetana. Nel 2006 la casa editrice e' stata assorbita dall’Istituto Shang Shung. L’attività editoriale prevede la

trascrizione, traduzione e pubblicazione degli insegnamenti orali dati da Chögyal Namkhai Norbu nei centri della Comunità Dzogchen Internazionale o in altre sedi, e la traduzione di testi tibetani originali per opera di traduttori qualificati. Nel corso degli anni la Shang Shung Edizioni ha pubblicato più di duecentocinquanta testi.

7

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Shang Shung Institute ItalyLocalità Merigar58031 Arcidosso (GR, Italy)Tel & fax: +39-0564-966940info@shangshunginstitute.orgwww.shangshunginstitute.orghttp://shop-it.shangshunginstitute.org

Shang Shung Institute AustriaGschmaier 1398265 Gr. Steinbach, AustriaCell phone: 0043 676 3221365Offi ce: 0043 3386 83218Fax: 0043 3386 83219www.shangshunginstitute.orgwww.ssi-austria.at

Shang Shung Institute of America18 Schoolhouse RdP.O. Box 278Conway, MA 01341, USAPhone (main-Anna) 413 369 4928Fax/Bookstore 413 369 4473www.shangshung.org

Shang Shung Institute of Tibetan StudiesThe London Centre for the Study of Traditional Tibetan Culture and KnowledgeKathy Cullen Administrator ++44 79 5086 [email protected]

Shang Shung Institute

The ancient Tibetan medi-cal system was the core of the Keynote Address given

by Chögyal Namkhai Norbu on September 11 in the auditorium of the Institute of Anatomy of Bo-logna University.

Bologna, capital of Traditional Tibetan Medicine for a day. On Saturday September 11 at 9 am, Prof. Namkhai Norbu, one of the most important living Masters of the Tibetan tradition, gave a keynote address entitled “Tibet-an Medicine, Patrimony of Man-kind” in the Auditorium of the Institute of Anatomy of the Uni-versity.

This was the fi rst time that the Auditorium of the Institute of Anatomy at Bologna University has been open for a public ad-dress.

The event which was organized by the Associazione per la Me-dicina Centrata sulla Persona (Association for Centered Per-son Medicine, Onlus – a Charity established according to the Ital-ian Law) in collaboration with the International Shang Shung Institute for Tibetan Studies, in acknowledgement of its overall signifi cance, has been granted of the following endorsements:

His Holiness the 14th Dalai LamaThe Presidency of the Council of MinistersThe Minister of Foreign AffairsThe Government of Emilia- Romagna RegionThe Government of the Province of BolognaThe Municipality of BolognaThe Faculty of Medicine, Univer-sity of Florence

The Italian Institute for Africa and the East, RomeThe European Medical Associa-tionThe European Association for Predictive, Preventive and Per-sonalised MedicineThe College and Council of MDs and Dentists of the Province of BolognaThe Observatory and Methods for Health, University of Milano-Bicocca)Bologna Local Health AuthorityNoopolis Foundation, Rome

The Keynote Address given by Professor Norbu was the fi rst public initiative at the interna-tional level by the Associazione per la Medicine Centrata sulla Persona Onlus, (Onlus is the Ital-ian acronym for a charity recog-nized by the Italian Law) a not-for-profi t association founded in 2007 in Bologna by psychiatrist Paolo Roberti di Sarsina, MD, one of the leading experts in Europe for the advancement of Tradi-tional, Complementary, Alterna-tive and Unconventional Medi-cine and member of the research consortium fi nanced by the Eu-

ropean Commission. Roberti di Sarsina explained, “Tibetan medicine is an ancient science in which some of its fundamental principles are listening carefully to the patient, a close global ex-amination (body, mind, energy, but also surrounding circum-stances) and personalized medi-cal care.

Therefore it is a therapeutic system that really has a lot to give to a West that has not come to terms with its own approach to the problem of suffering. It is an integral part of the Tibetan Tra-dition that is the patrimony of Mankind”. In Italy, 18.5 % of the population, more than 11 million people, have chosen to use non-conventional medicine (source: Eurispes); there were 8 million in 2005 (ISTAT data). The trend is even more impressive at the Eu-ropean level with more than 130 million citizens in the EU who regularly make use of non-con-ventional medicine.

This is a phenomenon of great importance which, however, ac-cording to Roberti di Sarsina, the Italian establishment is not responding to adequately. “Our

Parliament has not yet under-stood or wanted to set up that series of laws to regulate non conventional medicine that we have been waiting 20 years for. Yet, by now everyone is aware of the need to move from a type of unpersonalised medicine to one that is humanistic and promotes the health of the person taking into consideration his/her glo-bality and uniqueness. Our As-sociazione was created in order to contribute actively to this pro-cess”.

Emilia-Romagna is one of the regions that is focusing atten-tion on the change that is taking place as evidenced by the creation by the Regional Government, in 2004, of the Observatory for Non Conventional Medicine, of which Roberti di Sarsina is founding member, with the aim of giving rise to some experimental proj-ects within the Local Health Au-thority. The integrated bill pre-sented to the Health Commission of the Senate by proposer Sen. Daniele Bosone also includes the national bill sent to the Cham-bers, during the last legislature, by the Emilia-Romagna Region.

Strongly desidered by Paolo Roberti di Sarsina, the arrival in Bologna of Chöogyal Nam-khai Norbu Rinpoche, one of the highest level representatives of the Tibetan Tradition, shows the authority and commitment of the Associazione per la Medicina Centrata sulla Persona Onlus, as far asin promotingon and safe-guarding of suchthis Knowledg-es of Health are concerned.www.medicinacentratasullapersona.org

Chögyal Namkhai Norbu at Bologna University

More than 400 people attended Rinpoche’s lecture. The Main Hall was completely full and another lecture hall was equipped with a sound system to receive those who could not fi nd a place.

Update on Ka Ter Translation Project

With great pleasure I send you the latest in-formation about the

Ka-Ter Translation Project and the translation project Complete Works of Chögyal Namkhai Nor-bu.

Many of you have already experi-enced the value of being able to read the unique Dzogchen Teach-ings written by our Master, Chö-gyal Namkhai Norbu, in English, which, until recently, were avail-able only in Tibetan. Due to the tireless work of the translators and the editor, people do not have to learn Tibetan in order to read these texts, but can simply acquire them and thus have the marvelous opportunity to read

them. Just think of wonderful books like The Light of Kailash, Birth, Life and Death, Longchenpa’s Advice from the Heart, or The Rain-bow Body, and the great range of books and booklets that help each practitioner to apply the Teachings of our incomparable Master Chögyal Namkhai Norbu already made available by Shang Shung Edition.

Rinpoche has pointed out so many times, that a translator from Tibetan not only needs the capacity to translate the Tibetan words into English, but that one must have the capacity to trans-late the MEANING of these mar-velous texts. For many Tibetan words describing a certain state or understanding there does not exist an English term. For that reason a qualifi ed translator must know the meaning of the text and

must also have experienced the state that is explained.

The Shang Shung Institute Aus-tria is in charge of raising suffi -cient funds, so that the transla-tors and the editor can focus on their work and not have to earn their living through activities oth-er than translating or editing the precious texts, which Rinpoche offers us. All translators and the editor receive payment for their wonderful work. The funds for their income come exclusively from donors to the Internation-al Dzogchen Community – this means from YOU.

To raise funds for translation projects is not at all easy.

Though many donors have been very generous, the fact is that in 2010 we could not cover all the costs for the translation staff. For that reason we ask you to sup-

port our activities this year with special generosity.

Please read the detailed Report of Activities and please support our efforts, so that we can continue with our benefi cial work. Please donate directly with your cred-it card on our web safe site or get one of our Donation Pack-ages.

Thank you so much for all your support and dedication.Tashi Delegs and very best wishes,Oliver LeickCoordinator of the Ka-ter Trans-lation Project and Complete Works of Chögyal Namkhai Norbuwww.ssi-austria.at

Report of Activities of the International Shang Shung InstituteWe welcome you to read the de-tailed Report of Activities and to support our efforts so that we can continue with our work also for the benefi t of future generations.

Adriano ClementeIn 2010 Adriano Clemente worked on the following books:Rainbow Body: The Life and Realiza-tion of Togden Ugyen Tendzin Translated from Tibetan, edited and annotated by Adriano. Pub-lished in August 2010.

THE MIRROR · No. 106 · September, October 2010

06/09/10 22.42"Tibetan Medicine:Heritage of Mankind"

Pagina 1 di 2http://www.dzogchen.it/lp/conferenza_2010-09-11/index.php?lang=en

Association for Centred Person Medicine

Keynote Lecture by Prof. Chögyal Namkhai Norbu Rinpoche

"Tibetan Medicine:Heritage of Mankind"

Bologna, Saturday 11th September 2010, 9 AM

Main Hall, Institute of Human Anatomy, University of Bologna 48 Irnerio Street, Bologna

Endorsements:

His Holiness the 14th Dalai LamaThe Presidency of the Council of MinistersMinistry of Foreign AffairsRegional Government of Emilia-RomagnaProvincial Government of BolognaMunicipality of BolognaFaculty of Medicine, University of FlorenceItalian Institute for Africa and the East, RomeEuropean Medical AssociationEuropean Association for Predictive, Preventive and Personalised MedicineObservatory and Methods for Health, University of Milan-BicoccaProvince of Bologna College of MDs and DentistsBologna Local Health AuthorityNoopolis Foundation, Rome

Scientific Secretariat: Paolo Roberti di Sarsina, Luigi Ottaviani, Alfredo Vannacci Organizing Secretary: Paolo Roberti di Sarsina, Nadia Gaggioli, Luigi Ottaviani, Cesare Pilati

10/09/10 08.16Unione Buddhista Italiana - UBI

Pagina 1 di 3http://www.buddhismo.it/

UBI - Unione Buddhista ItalianaEnte Religioso riconosciuto con D.P.R. 3-1-1991

Associata all’Unione Buddhista Europea

N e w s

Comunicati Stampa

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Tel. 349-2543115martedì e giovedì

dalle 17.00 alle 19.00 mercoledì

dalle 10.00 alle 12.00

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UBI: L'Ente UBI: I Centri UBI: Eventi

UBI e società Il Buddhismo Mappa del sito

Lezione Magistrale del Prof. Namkhai Norbu

"La Medicina Tibetana: patrimonio dell'Umanità"

Bologna, sabato 11 settembre 2010, ore 9:00Aula Magna, Istituto di Anatomia Umana Normale, Università di Bologna, via Irnerio 48

Locandina (pdf 581 kb)

Il Lama Tenzin Khenrab Rinpoche in esclusiva su LifeGate.it

dal 9 giugno, LifeGate.it dedica uno speciale al Lama Tenzin Khenrab Rinpoche,reincarnazione del XIII Thamtog e guida spirituale del Centro Ghe Pel Ling di Milano, coninterviste esclusive e video del Venerabile Maestro. Molti i temi trattati da questa illustrepersonalità, tra cui l’ambiente, la felicità e la società ... (continua)

Diventa Amico del Centro Ewam

Il Centro Ewam di Firenze apre una sottoscrizione straordinaria allo scopo diraccogliere fondi per l’acquisto di una sede permanente.

Locandina (pdf 1,04 Mb)

10/09/10 08.16Unione Buddhista Italiana - UBI

Pagina 1 di 3http://www.buddhismo.it/

UBI - Unione Buddhista ItalianaEnte Religioso riconosciuto con D.P.R. 3-1-1991

Associata all’Unione Buddhista Europea

N e w s

Comunicati Stampa

[email protected]

Tel. 349-2543115martedì e giovedì

dalle 17.00 alle 19.00 mercoledì

dalle 10.00 alle 12.00

Info e contatti

Coloro che ci hannopreceduto

Vesakwww.vesak.it

Passi in Pacewww.passinpace.it

Carta dei valori,

della cittadinanza e

dell'integrazione

Dichiarazione

Buddhista sui

Cambiamenti

Climatici

Archivio

UBI: L'Ente UBI: I Centri UBI: Eventi

UBI e società Il Buddhismo Mappa del sito

Lezione Magistrale del Prof. Namkhai Norbu

"La Medicina Tibetana: patrimonio dell'Umanità"

Bologna, sabato 11 settembre 2010, ore 9:00Aula Magna, Istituto di Anatomia Umana Normale, Università di Bologna, via Irnerio 48

Locandina (pdf 581 kb)

Il Lama Tenzin Khenrab Rinpoche in esclusiva su LifeGate.it

dal 9 giugno, LifeGate.it dedica uno speciale al Lama Tenzin Khenrab Rinpoche,reincarnazione del XIII Thamtog e guida spirituale del Centro Ghe Pel Ling di Milano, coninterviste esclusive e video del Venerabile Maestro. Molti i temi trattati da questa illustrepersonalità, tra cui l’ambiente, la felicità e la società ... (continua)

Diventa Amico del Centro Ewam

Il Centro Ewam di Firenze apre una sottoscrizione straordinaria allo scopo diraccogliere fondi per l’acquisto di una sede permanente.

Locandina (pdf 1,04 Mb)

TERMINOLOGY IN BIOMEDICAL LITERATURE IN ENGLISH LANGUAGE

Il termine “Tradi&onal Medicine” fa la sua prima comparsa su una rivista di biomedicina in lingua inglese su PubMed nel 1952. Il termine “Person Centred Medicine” appare per la prima volta nel 1974. I termini “Medicina Alterna&va”, “Medicina Complementare” e “Medicina Integra&va” hanno un’origine recente nella leDeratura biomedica. Facendo riferimento a Medline e PubMed il termine “Alterna&ve Medicine” apparve per la prima volta in una rivista di biomedicina nel 1975 allorquando “Nursing Times” iniziò a pubblicare una serie di arKcoli sulla Meditazione Trascendentale, la Guarigione Spirituale e la Medicina OmeopaKca. Il termine “Unconven&onal Medicine” appare per la prima volta su PubMed nel 1983. Sempre facendo riferimento ai sopracitaK database, la prima volta in cui appare il termine “Complementary Medicine” risale al 1985 quando il Lancet pubblicò l’arKcolo dal Ktolo: “Complementary Medicine in the United Kingdom”. Invece il termine “Integra&ve Medicine” viene introdoDo in una rivista di biomedicina in lingua inglese nel 1995. “Alterna&ve and Complementary Medicine” risale su PubMed al 1991. Mentre il termine “Complementary and Alterna&ve Medicine” compare per la prima volta su PubMed in un arKcolo del 1996. Invece i primi due arKcoli indicizzaK su PubMed nel cui Ktolo si ritrova il termine TradiKonal Asian Medicine e Asian TradiKonal Medicine sono rispeYvamente dell’anno 1988 e dell’anno 2000. TradiKonal East Asian Medicine appare nel 2012. Complementary, AlternaKve and IntegraKve Medicine nel 2013.

Riassumendo: prima comparsa nella le6eratura biomedica di lingua inglese su PubMed:

1.  TradiMonal Medicine (TM) 1952 2.  Person Centred Medicine (PCM) 1974

3.  AlternaMve Medicine (AM) 1975 4.  UnconvenMonal Medicine (UM) 1983 5.  Complementary Medicine (CM) 1985

6.  AlternaMve and Complementary Medicine (ACM) 1991 7.  IntegraMve Medicine (IM) 1995

8.  Complementary and AlternaMve Medicine (CAM) 1996 9.  TradiMonal Asian Medicine (TAM) 1988 10. Asian TradiMonal Medicine (ATM) 2000

11. TradiMonal East Asian Medicine (TEAM) 2012 12. Complementary, AlternaMve and IntegraMve Medicine (CAIM) 2013

COMPLEMENTARY AND ALTERNATIVE MEDICINE (CAM) CAM (Complementary and Alternative Medicine) è acronimo ampiamente diffuso nella letteratura internazionale ma non completamente accettato. Tale definizione è stata coniata nel 1997 alla Conferenza del United States Office for Alternative Medicine of the National Institutes of Health (successivamente eretto dal Governo Federale a National Center for Complementary and Alternative Medicine, NCCAM) e successivamente adottato dal Cochrane Collaboration e dal Ministerial Advisory Committee on Complementary and Alternative Medicine: “Complementary and alternative medicine (CAM) is a broad domain of healing resources that encompasses all health systems, modalities and practices and their accompanying theories and beliefs, other than those intrinsic to the politically dominant health system of a particular society or culture in a given historical period. CAM includes all such practices and ideas self-defined by their users as preventing or treating illness or promoting health and well-being. Boundaries within CAM and between the CAM domain and that of the dominant system are not always sharp or fixed.”

Differences between Western Medicine and TM/CAM

The main philosophy of Western Medicine is that if the human body is struck by diseases, the causative agent must be identified and dealt with in order to return patients to a state of good health. A common feature of most systems of Traditional Medicine is that they take a “holistic” approach towards the sick individual and treat disturbances on the physical, emotional, mental and living environment levels simultaneously. Dr Xiaorui Zhang, former Coordinator Traditional Medicine, Department of Health System Governance and Service Delivery, World Health Organization

Perspectives on Complementaryand Alternative Medicine Research

For the last 2 decades, the phrase “complementary andalternative medicine” has been used to describe a widearray of treatments, health practices, and practitionerdisciplines with historical roots outside conventionalmedicine. Examples include ancient practices such asacupuncture; herbal remedies; visits to complemen-tary clinicians including naturopaths, homeopaths, andchiropractors; and meditative practices such as mind-fulness, yoga, and tai chi. Data from the 2007 NationalHealth Interview Survey show that about 40% of US resi-dents integrate 1 or more of these unconventional healthpractices into their personal health care,1 spending about$34 billion per year out of pocket.2

The widespread use of these practices perplexesmany physicians. Concerns include scientific implausi-bility, unjustified claims of benefit, possible adverse ef-fects, interactions with prescribed treatments, adulter-ated products, and the possibility that vulnerablepatients with serious diseases may be misled.

The National Institutes of Health’s (NIH’s) efforts toaddress these concerns began in earnest in 1999, driventoward 2 ends: filling gaps in scientific evidence aboutefficacy and safety and exploring the possibility of real

benefit in some practices of interest to the public. Theefforts have included both large, multicenter clinical trialsand a wide-ranging portfolio of exploratory, investigator-initiated, basic and clinical research projects.

That this public sector investment has been the sub-ject of intense debate3 is not surprising. If well-informed, such debate is welcome. However, some criti-cisms betray a lack of understanding of scientific progressin this field and how it has shaped a compelling, sharplyfocused research agenda. In this Viewpoint, we de-scribe the 2013 NIH perspective on investment in re-search on these interventions and call for a more nu-anced conversation about them.

What Have We Learned?National surveys suggest that approximately half ofUS residents’ use of these complementary and alterna-tive therapies is to treat symptoms, particularly chronicpain.1 The other half is used to promote physical healthor psychological well-being.1 Although much of this useis self-administered, it is most often combined with con-

ventional care. Use to replace proven conventional treat-ment—although of substantial concern—is uncommon.1

Moreover, many mainstream institutions, both ci-vilian and military, are integrating some of these ap-proaches into the care they provide.2 Marketing to con-sumer demand in the US health care system undoubtedlyis driving some of this integration, ahead of evidenceabout safety and efficacy.

For some mind-body approaches, however, thereis mounting evidence of usefulness and safety, par-ticularly in relieving chronic pain. A few examplesinclude acupuncture for osteoarthritis pain; tai chi forfibromyalgia pain; and massage, spinal manipulation,and yoga for chronic back pain.4 Increasing comfortwith this emerging evidence is reflected in practiceguidelines from the American College of Physicians,the American Pain Society, and the Department ofDefense.5,6

Translational research is also elucidating effects ofinterventions like meditation and acupuncture on cen-tral mechanisms of pain perception and processing, regu-lation of emotion and attention, and placebo re-sponses. Although not yet fully understood, these effects

point toward scientifically plausiblemechanisms—often unrelated to the tra-ditional mechanistic explanations—bywhich these interventions might exertbenefit.

Another major focus of past NIH in-vestments has been on rigorous, appro-priately powered, placebo-controlledtrials of widely used dietary supple-

ments. These include St John’s wort for major depres-sion, glucosamine and chondroitin sulfate for knee os-teoarthritis, silymarin for chronic liver disease, sawpalmetto for benign prostatic hyperplasia, ginkgo forearly cognitive decline, and vitamin E and selenium toprevent prostate cancer.7 The results of these large stud-ies failed to confirm benefits seen in earlier preliminarystudies. Although many were disappointed, this body ofwork has had well-documented influences on con-sumer use and spending8 and has contributed evi-dence to systematic reviews. In addition, high-qualitydata sets from these studies are being used to examineother important health research questions.

Other research on natural products has yieldedimportant information about safety concerns, includ-ing toxicities of specific products, herb-drug interac-tions, and instances of product contamination or adul-teration. This work has contributed to regulatoryactions aimed at consumer protection and has argu-ably heightened awareness that “natural does notmean safe.”

For some mind-body approaches,however, there is mounting evidence ofusefulness and safety, particularly inrelieving chronic pain

VIEWPOINT

Josephine P. Briggs,MDNational Center forComplementary andAlternative Medicine,National Institutes ofHealth, Bethesda,Maryland.

Jack Killen, MDNational Center forComplementary andAlternative Medicine,National Institutes ofHealth, Bethesda,Maryland.

CorrespondingAuthor: Josephine P.Briggs, MD, NationalCenter for Complemen-tary and AlternativeMedicine, 31 Center Dr,Bldg 31, Ste 2B11,Bethesda, MD 20814([email protected]).

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Briggs JP, Killen JK. PerspecMves on Complementary and AlternaMve Medicine Research. JAMA 2013;310(7):691-‐692.

Perspectives on Current Researchand Future DirectionsThese investments of a small fraction of public sector health re-search dollars have begun to meet the need for better evidence aboutthese widely used interventions and clarify the potential of some forintegration into patient care. A new set of priorities has evolved,shaped around emerging evidence of efficacy and safety, amena-bility to rigorous investigation, and practical but important publichealth needs.

One research priority is focused on symptom management—specifically the role of mind-body interventions in managing pain andother symptoms common to many chronic diseases. All physiciansunderstand the limits of current treatments for chronic pain and thepotential value of nonpharmacological interventions. This priorityalso encompasses research to better understand the mechanisms—including placebo responses—that could be exploited to mediate ormodulate these symptoms.

Similarly, research on natural products—dietary supplements,herbal medicines, and probiotics—has also been focused consider-ably. Priorities now include translational research to elucidate bio-logical actions and provide a sound mechanistic foundation for po-tential clinical studies and include the development of a strongtechnological platform for systematic study of herb-drug and herb-

herb interactions using state-of-the-art methods of pharmacology,pharmacognosy, genomics, and proteomics.

Debate about NIH efforts in this area is vital to ensuring that valu-able research resources are wisely invested. However, the debaterequires a more nuanced conversation than has often been the casein the past.

First and foremost, the conversation should reflect current reali-ties, includingtheevolutionofresearchprioritiesandtheshifts infund-ing to projects that address them, rather than areas that have less sci-entific promise or less amenability to scientific investigation. Second,although discussions about complementary and alternative medi-cine often imply a clear demarcation distinguishing a monolithic al-ternative domain from conventional medicine, this distinction breaksdownintherealitiesofthepluralisticUShealthcaresystem.Thebound-aries also shift—in both directions—as evidence changes. Third, theconversation should recognize the state of current evidence indicat-ing that some of these practices are useful and can appropriately beintegrated into care, some should not, some are dangerous and meritregulatory attention, and many are somewhere in between.

A more nuanced conversation about this field and its researchcan improve the dialogue between health care professionals and pa-tients, foster better research partnerships, and facilitate patient ac-cess to interventions that may be helpful.

ARTICLE INFORMATION

Conflict of Interest Disclosures: All authors havecompleted and submitted the ICMJE Form forDisclosure of Potential Conflicts of Interest andnone were reported.

REFERENCES

1. Barnes PM, Bloom B, Nahin RL. Complementaryand alternative medicine use among adults andchildren: United States, 2007. Natl Health Stat Rep.2008;(12):1-23.

2. Schultz AM, Chao SM, McGinnis JM. IntegrativeMedicine and the Health of the Public: A Summary ofthe February 2009 Summit. Washington, DC:National Academies Press; 2009.

3. Offit PA. Studying complementary andalternative therapies. JAMA. 2012;307(17):1803-1804.

4. Spotlighted research results—chronic pain.National Center for Complementary and AlternativeMedicine, NIH website. http://nccam.nih.gov/health/556/research. Accessed April 24, 2013.

5. Chou R, Qaseem A, Snow V, et al; Clinical EfficacyAssessment Subcommittee of the American Collegeof Physicians; American College of Physicians;American Pain Society Low Back Pain GuidelinesPanel. Diagnosis and treatment of low back pain: ajoint clinical practice guideline from the AmericanCollege of Physicians and the American PainSociety. Ann Intern Med. 2007;147(7):478-491.

6. Pain Management Task Force Report: providinga standardized DoD and VHA vision and approachto pain management to optimize the care forwarriors and their families. Office of The ArmySurgeon General. http://www.armymedicine.army.mil/reports/Pain_Management_Task_Force.pdf.May 2010. Accessed April 24, 2013.

7. Spotlighted research results—dietarysupplements. National Center for Complementaryand Alternative Medicine, NIH website.http://nccam.nih.gov/health/13/research. AccessedApril 24, 2013.

8. NBJ’s Supplement Business Report 2012. NewYork, NY: Penton Media; 2012.

Opinion Viewpoint

692 JAMA August 21, 2013 Volume 310, Number 7 jama.com

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Briggs JP, Killen JK. PerspecMves on Complementary and AlternaMve Medicine Research.

JAMA 2013;310(7):691-‐692.

Barnes et al., CDC NHS # 12 2008

: Definition of Integrative Medicine Integrative Medicine is the practice of medicine that reaffirms the importance of the relationship between practitioner and patient, focuses on the whole person, is informed by evidence, and makes use of all appropriate therapeutic approaches, healthcare professionals and disciplines to achieve optimal health and healing. Developed and Adopted by The Consortium, May 2004 Edited May 2005

http://www.imconsortium.org

University of California, San Francisco

Duke University

University of Maryland

University of Massachusetts

University of Arizona

Harvard University

1999: 8 Institutions

Stanford University

University of Minnesota

Albert Einstein/Yeshiva University Boston University Columbia University Duke University Georgetown University George Washington University Harvard Medical School Johns Hopkins University Laval University, Quebec Mayo Clinic McMaster University, Ontario Northwestern University Ohio State University Oregon Health & Science University Stanford University Thomas Jefferson University University of Alberta University of Arizona University of Calgary

University of Maryland University of Massachusetts University of Medicine &

Dentistry of New Jersey University of Michigan University of Minnesota University of New Mexico University of North Carolina,

Chapel Hill University of Cincinnati University of Pennsylvania University of Pittsburgh University of Texas University of Vermont University of Washington University of Wisconsin Vanderbilt University Wake Forest University Yale University

University of Connecticut University of Hawaii University of Illinois University of Kansas

University of California, Irvine University of California, Los Angeles University of California, San Francisco University of Colorado

2009: 44 Members

* *

* *

National Efforts Addressing CAM Integration in Education

•  NIH-Funded Inst i tu t ions (R25 Grants) Undertaking Curricular Initiatives (15)

•  Consortium of Academic Health Centers for Integrative Medicine (30) (est. 2002)

•  Policy Initiatives: –  White House Commission on CAM Policy (2002) –  National Policy Dialogue Report (2002) –  Institute of Medicine (IOM) Committee on CAM (Jan

2005) –  National Education Dialogue (June 2005)

Institute of Medicine (IOM) Study on CAM

Recommendation on Education “The committee recommends that health profession schools (e.g. schools of medicine, nursing, pharmacy, and allied health) incorporate sufficient information about CAM into the standard curriculum…to enable licensed professionals to competently advise their patients about CAM.”

Report Issued: January 12, 2005

USA number of postgraduate CAM qualifications 1995-2010

Differences between the biomedical and holistic model

Model

Biopsychosocial

Biomedical

Body/mind as a system interlinked with other systems

Mind/body separation; body as an object

Emphasis

Health

Disease

Priority

Prevention

Curative

Diagnostic focus

Whole person in his/her social & psychological environment

Localised tissue disruption & specific pathogen

Treatment approach

Support vis medicatrix naturae; restoring balance to the whole psychosomatic system

Intervention in disease pathway; symptomatic

Individualization/standardization

Individualization of care

Standardization of care

Long-term/short-term

A long-term focus on creating and maintaining health and well-being

Aggressive intervention with emphasis on short-term results

Military metaphor for therapy

Stimulate the home forces

Search and destroy the invader

Patient/physician relationship

Authority and responsibility inherent in each individual; c o - o p e r a t i v e p a r t n e r s h i p ; empowering

Authority and responsibility inherent in prac t i t ioner, no t pa t ien t ; paternalistic; disempowering

[Comparison of the Biopsychosocial and Biomedical model; adapted from Millenson and Davis-Floyd]

Dr. Xiaroui Zhang Former Coordinator Traditional Medicine

Department

WHO and Traditional Medicine WHO HQ Geneva, 26.04.06

Traditional and Complementary MedicineTraditional Medicine is the sum total of the knowledge,skills, and practices based on the theories, beliefs, andexperiences indigenous to different cultures, whetherexplicable or not, used in the maintenance of health as

well as in the prevention, diagnosis, improvement or treatment ofphysical and mental illness.

More information

NEW! WHO Traditional Medicine Strategy: 2014-2023Definitions of Traditional medicine termsWHO Collaborating Centres for Traditional medicineExecutive Board and World Health Assembly ResolutionsPublications

WHO's Support for Regulation of Herbal Medicines

International Regulatory Cooperation for Herbal Medicines (IRCH)

Informations sources supported by WHO Regional Offices

SEARO - South East AsiaHerbalNet - Digital Repository in Herbal Medicines

WPRO - Western Pacific RegionGHL WPRO Country Focus

Highlights of the first WHO Congress on Traditional Medicine"Beijing Declaration"

For further enquiries please contact:E-mail: [email protected]

Dr Zhang QiHSS/HPW/TRMWHO/GenevaFax: +41 22 791 4153

Medicines publications

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Traditional medicine (TM) refers to the knowledge, skills and practicesbased on the theories, beliefs and experiences indigenous to differentcultures, used in the maintenance of health and in the prevention,diagnosis, improvement or treatment of physical and mental illness.Traditional medicine covers a wide variety of therapies and practices whichvary from country to country and region to region. In some countries, it isreferred to as "alternative" or "complementary" medicine (CAM).

Traditional medicine has been used for thousands of years with greatcontributions made by practitioners to human health, particularly as primaryhealth care providers at the community level. TM/CAM has maintained itspopularity worldwide. Since the 1990s its use has surged in manydeveloped and developing countries.

General information

Fact sheet: traditional medicineQ&A: How safe is traditionalmedicine?

WHO programmes and activities

Department of Essential Medicinesand Pharmaceutical Policies (EMP)

Traditional medicines in WHOregions

South-East Asian RegionWestern Pacific Region

Technical information

Traditional medicines: definitions

More about traditional medicine

Publications

Traditional medicines strategy [pdf500kb]National policy on traditionalmedicine and regulation of herbalmedicines

More publications on traditionalmedicine

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World Health Organization General Guidelines for Methodologies on Research and Evaluation of Traditional Medicine (Geneva, 2000)

Traditional medicine – Definitions

Traditional medicine has a long history. It is the sum total of the knowledge, skills and practices based on the theories, beliefs and experiences indigenous to different cultures, whether explicable or not, used in the maintenance of health, as well as in the prevention, diagnosis, improvement or treatment of physical and mental illnesses.

The terms complementary/alternative/non-conventional medicine are used interchangeably with traditional medicine in some countries.

The World Health Organisation defines it as follows: Complementary and Alternative Medicine (CAM) refers to a broad set of health care practices that are not part of a country's own tradition and not integrated into the dominant health care system. Other terms sometimes used to describe these health care practices include “natural medicine”, “non-conventional medicine” and “holistic medicine”.

WHO Traditional Medicine Strategy 2002-2005

integrate TM/CAM with national health care systems

provide evaluation, guidance and support for effective regulation

ensure avai labi l i ty and affordability of TM/CAM, including essential herbal medicines

P r o m o t e therapeutically-sound use of TM/CAM by providers and consumers

1

2

3

4

Policy:

Safety, efficacy and quality:

Access:

Rational use:

WHO Traditional Medicine Strategy 2002–2005 — objectives, components and expected outcomes

Objectives Components

Expected outcomes POLICY: Integrate TM/CAM with national health care systems, as appropriate, by developing and implementing national TM/CAM policies and programs

1. Recognition of TM/CAM Help countries to develop national policies and programmes on TM/CAM

1.1 Increased government support for TM/CAM, through comprehensive national policies on TM/CAM 1.2 Relevant TM/CAM integrated into national health care system services

2. Protection and preservation of indigenous TM knowledge relating to health Help countries to develop strategies to protect their indigenous TM knowledge

2.1 Increased recording and preservation of indigenous knowledge of TM, including development of digital TM libraries

SAFETY, EFFICACY AND QUALITY: Promote the safety, efficacy and quality of TM/CAM by expanding the knowledge-base on TM/CAM, and by providing guidance on regulatory and quality assurance standards

3. Evidence-base for TM/CAM Increase access to and extent of knowledge of the safety, efficacy and quality of TM/CAM, with an emphasis on priority health problems such as malaria and HIV/AIDS

3.1 Increased access to and extent of knowledge of TM/CAM through networking and exchange of accurate information 3.2 Technical reviews of research on use of TM/CAM for prevention, treatment and management of common diseases and conditions 3.3 Selective support for clinical research into use of TM/CAM for priority health problems such as malaria and HIV/AIDS, and common diseases

4. Regulation of herbal medicines Support countries to establish effective regulatory systems for registration and quality assurance of herbal medicines

4.1 National regulation of herbal medicines, including registration, established and implemented 4.2 Safety monitoring of herbal medicines and other TM/CAM products and therapies

5. Guidelines on safety, efficacy and quality Develop and support implementation of technical guidelines for ensuring the safety, efficacy and quality control of herbal medicines and other TM/CAM products and therapies

5.1 Technical guidelines and methodology for evaluating safety, efficacy and quality of TM/CAM 5.2 Criteria for evidence-based data on safety, efficacy and quality of TM/CAM therapies

ACCESS: Increase the availability and affordability of TM/CAM, as appropriate, with an emphasis on access for poor populations

6. Recognition of role of TM/CAM practitioners in health care Promote recognition of role of TM/CAM practitioners in health care by encouraging interaction and dialogue between TM/CAM practitioners and allopathic practitioners

6.1 Criteria and indicators, where possible, to measure cost-effectiveness and equitable access to TM/CAM 6.2 Increased provision of appropriate TM/CAM through national health services 6.3 Increased number of national organizations of TM/CAM providers

7. Protection of medicinal plants Promote sustainable use and cultivation of medicinal plants 7.1 Guidelines for good agriculture practice in relation to medicinal

plants 7.2. Sustainable use of medicinal plant resources

RATIONAL USE: Promote therapeutically sound use of appropriate TM/CAM by providers and consumers

8. Proper use of TM/CAM by providers Increase capacity of TM/CAM providers to make proper use of TM/CAM products and therapies

8.1 Basic training in commonly used TM/CAM therapies for allopathic practitioners 8.2 Basic training in primary health care for TM practitioners

9. Proper use of TM/CAM by consumers Increase capacity of consumers to make informed decisions about use of TM/CAM products and therapies

9.1 Reliable information for consumers on proper use of TM/CAM therapies 9.2 Improved communication between allopathic practitioners and their patients concerning use of TM/CAM

LINEE GUIDA PER LO SVILUPPO DI INFORMAZIONI PER IL CONSUMATORE PER UN USO APPROPRIATO DI MEDICINA TRADIZIONALE, COMPLEMENTARE E ALTERNATIVA

World Health Organization: Global Atlas of Traditional, Complementary and Alternative Medicine. Centre for Health Development, Kobe, Japan, 2005

Beijing Declaration

Adopted by the WHO Congress on Traditional Medicine, Beijing, China, 8 November 2008 Participants at the World Health Organization Congress on Traditional Medicine, meeting in Beijing this eighth day of November in the year two thousand and eight; Recalling the International Conference on Primary Health Care at Alma Ata thirty years ago and noting that people have the right and duty to participate individually and collectively in the planning and implementation of their health care, which may include access to traditional medicine; Recalling World Health Assembly resolutions promoting Traditional Medicine, including WHA56.31 on Traditional Medicine of May 2003; Noting that the term “Traditional Medicine" covers a wide variety of therapies and practices which may vary greatly from country to country and from region to region, and that Traditional Medicine may also be referred to as alternative or complementary medicine;

Recognizing Traditional Medicine as one of the resources of primary health care services to increase availability and affordability and to contribute to improve health outcomes including those mentioned in the Millennium Development Goals; Recognizing that Member States have different domestic legislation, approaches, regulatory responsibilities and delivery models; Noting that progress in the field of Traditional Medicine has been obtained in a number of Member States through implementation of the WHO Traditional Medicine Strategy 2002‐2005; Expressing the need for action and cooperation by the international community, governments, and health professionals and workers, to ensure proper use of Traditional Medicine as an important component contributing to the health of all people, in accordance with national capacity, priorities and relevant legislation; In accordance with national capacities, priorities, relevant legislation and circumstances, hereby make the following Declaration:

1. The knowledge of Traditional Medicine, treatments and practices should be respected, preserved, promoted and communicated widely and appropriately based on the circumstances in each country. 2. Governments have a responsibility for the health of their people and should formulate national policies, regulations and standards, as part of comprehensive national health systems to ensure appropriate, safe and effective use of Traditional Medicine. 3. Recognizing the progress of many governments to date in integrating Traditional Medicine into their national health systems, we call on those who have not yet done so to take action.

4. Traditional Medicine should be further developed based on research and innovation in line with the "Global strategy and plan of action on public health, innovation and intellectual property" adopted at the Sixty‐first World Health Assembly in Resolution WHA61.21 in 2008. Governments, international organizations and other stakeholders should collaborate in implementing the global strategy and plan of action. 5. Governments should establish systems for the qualification, accreditation or licensing of Traditional Medicine practitioners. Traditional Medicine practitioners should upgrade their knowledge and skills based on national requirements. 6. The communication between conventional and Traditional Medicine providers should be strengthened and appropriate training programmes be established for health professionals, medical students and relevant researchers.

Integration of TM/CAM into National Health Systems

“The two systems of traditional and western medicine need not clash. Within the context of primary health care, they can blend together in a beneficial harmony, using the best features of each system, and compensating for certain weaknesses in each”

Dr Margaret Chan, Director-General of WHO at Opening ceremony of WHO Congress 7th November 2008, Beijing

Countries’ Progress in the Field of Traditional Medicine

Number of countries before 1990: 5

Number of countries in 2007: 48

0

10

20

30

40

50

5 7 11 17 25 34 41 44 48

Before 1990

1990 - 1991

1992 - 1993

1994 - 1995

1996 - 1997

1998 - 1999

2000 - 2001

2002 - 2003 2007

Number of countries with national policy

pending: 51

31% of respondents

have national policy

Number of Member States with national policy on TM/CAM

WHO Global Survey on National Policy and Regulation of Herbal Medicines 2005 and WHO medicine strategy 2008-2014


Number of countries before 1986: 14

Number of countries in 2007: 110

65% of respondents have

established herbal medicines

law or regulations

42 (49%) declared regulations were in the process of being developed.

Number of Member States with herbal medicines law or regulations

WHO Global Survey on National Policy and Regulation of Herbal Medicines 2005 and WHO medicine strategy 2008-2014

62

12 1521

2531

3641 43

58

0

10

20

30

40

50

60

70

1970 1975 1980 1985 1990 1995 2000 2003 2005 2007

Year

Num

ber

of M

embe

r St

ates


Number of Member States with a national research institute on TM/CAM or herbal medicines

New trend in integrating/including TM/CAM practice into Health Services

§  Hungary 1997 §  Belgium 1999 §  Ghana 1999 §  Ukraine 1998 §  Myanmar 2000 §  Russian Federation 2001 §  Singapore 2001 and 2002 §  Tanzania 2002 §  Indonesia 2002 and 2007 §  Norway 2003 §  Portugal 2003 §  Brazil 2006 §  UK 2008

The countries have established national law and regulation for practice of TM/AM therapies

FIFTY-SIXTH WORLD HEALTH ASSEMBLY Resolution 56.31

Traditional medicine

WHO New Resolution on Traditional Medicine Resolution World Health Assembly 62.13 adopted on 26 May 2009

The WHA Resolution emphasizes: Ø To preserve and communicate knowledge of Traditional

Medicine; Ø To formulate national policies, regulations and standards of

Traditional Medicine; Ø To integrate Traditional Medicine into national health

systems; Ø To develop research and innovation; Ø To establish qualifications and licensed practice; Ø To strengthen communication between conventional and

Traditional Medicine providers.

WHA 62.12 on primary health care, including health system strengthening

Request WHO to foster alignment and coordination of global interventions for health system strengthening, basing them on the primary health care approach, in collaboration with Member States, relevant international organizations, international health initiatives, and other stakeholders in order to increase synergies between international and national priorities; WHO restructure Traditional Medicine: Traditional Medicine Programme is relocated in the Department of Health System Governance and Service Delivery

Renewed priority areas of WHO’s Traditional Medicine

v Capitalizing on the potential contribution of Traditional Medicine to self-care and to people-centred primary care

v Modality for integration of Traditional Medicine into

health systems v Promoting agreement and consensus on criteria for

endorsement, integration, and evaluation of Traditional Medicine as a subsystem of national health systems

v Strengthening research to promote the quality, safety and efficacy of traditional medicines and products

Research for Integrative Medicine

Two priority areas

Technical research: the research related to further develop Traditional Medicine and focus on safety, quality and efficacy of products and practice etc Social research: the research related to evaluation role of Traditional Medicine in the healthy system, the models of integration of TM into healthy system, evaluation of cost-effectiveness etc

²  The characteristics and special theory of TM/CAM should not be ignored in the research

²  Communication between TM/CAM practitioners and conventional

health professionals and researchers should be further strengthened ²  Multiple training/education of TM/CAM for conventional health

professionals and researchers as well medicinal students should be considered

²  Standards and terminology standards of TM/CAM could be play as the

bridge to facilitate communication between TM/CAM practitioners and conventional professionals

²  Appropriate research methodology and approaches is crucial related to

the results of the research. Need efforts to develop the appropriate research methodology and approaches.

Appropriate research methodology and approaches for Traditional Medicine

UNESCO

Acupuncture and Moxibustion of Traditional Chinese Medicine

Inscribed in 2010 on the Representative List of the Intangible Cultural Heritage of Humanity Description Acupuncture and Moxibustion are forms of Traditional Chinese Medicine widely practised in China and also found in regions of south-east Asia, Europe and the Americas. The theories of Acupuncture and Moxibustion hold that the human body acts as a small universe connected by channels, and that by physically stimulating these channels the practitioner can promote the human body’s self-regulating functions and bring health to the patient. This stimulation involves the burning of moxa (mugwort) or the insertion of needles into points on these channels, with the aim to restore the body’s balance and prevent and treat disease. In Acupuncture, needles are selected according to the individual condition and used to puncture and stimulate the chosen points. Moxibustion is usually divided into direct and indirect moxibustion, in which either moxa cones are placed directly on points or moxa sticks are held and kept at some distance from the body surface to warm the chosen area. Moxa cones and sticks are made of dried mugwort leaves. Acupuncture and moxibustion are taught through verbal instruction and demonstration, transmitted through master-disciple relations or through members of a clan. Currently, Acupuncture and Moxibustion are also transmitted through formal academic education. Decision 5.COM 6.6 The Committee (…) decides that [this element] satisfies the criteria for inscription on the Representative List, as follows: R1: Acupuncture and moxibustion are a traditional knowledge and practice being transmitted from generation to generation and recognized by Chinese communities worldwide as part of their intangible cultural heritage; R2: Their inscription on the Representative List could contribute to raising awareness concerning traditional medicine worldwide, while promoting cultural exchange between China and other countries; R3: A set of present and future safeguarding measures aim at protecting and promoting the element, supported by the commitments of the State, the communities and the skill-bearers to their implementation; R4: The nomination demonstrates that practitioners have participated in the nomination process and have provided their free, prior and informed consent; R5: Acupuncture and moxibustion are inscribed on the National List of Intangible Cultural Heritage administered by the Department of Intangible Cultural Heritage of the Ministry of Culture.

http://www.unesco.org/culture/ich/index.php?lg=en&pg=00011&RL=00425

WHO to define information standards for Traditional Medicine WHO will develop, for the first time, a classification of Traditional Medicine, paving the way for the objective evaluation of its benefits.

Creating an evidence base for Traditional Medicine The International Classification of Traditional Medicine project will assist in creating an evidence base for Traditional Medicine - producing terminologies and classifications for diagnoses and interventions. “We recognize that the use of Traditional Medicine is widespread. For many people – especially in the Western Pacific, South-East Asia, Africa and Latin America – Traditional Medicine is the primary source of health care,” said Dr Marie-Paule Kieny, Assistant Director-General of Innovation, Information, Evidence and Research at WHO. “Throughout the rest of the world, particularly Europe and North America, use of herbal medicines, acupuncture, and other traditional medicine practices is increasing. Global classification and terminology tools, for Traditional Medicine, however, have been lacking.”

International platform to harmonize data The International Classification of Traditional Medicine will have an interactive web-based platform to allow users from all countries to document the terms and concepts used in Traditional Medicine. “Several countries have created national standards for the classification of Traditional Medicine but there is no international platform that allows the harmonization of data for clinical, epidemiological and statistical use. There is a need for this information to allow clinicians, researchers and policy-makers to comprehensively monitor safety, efficacy, use, spending and trends in health care," said Kieny. The classification will initially focus on Traditional Medicine practices from China, Japan and the Republic of Korea that have evolved and spread worldwide. Tokyo 7 December 2010 http://www.who.int/mediacentre/news/notes/2010/trad_medicine_20101207/en/print.html

WHO Benchmarks for Training in Traditional Complementary and Alternative Medicine http://www.who.int/medicines/areas/traditional/trm_benchmarks/en/index.html

SHS/EGC/IBC-19/12/3 Rev.

Paris, 8 February 2013 Original: English/French

REPORT OF THE IBC ON TRADITIONAL MEDICINE SYSTEMS AND THEIR ETHICAL IMPLICATIONS

UNESCO’s International Bioethics Committee included the subject of traditional medicine in its work programme for 2010-2011. A working group was set up and asked to consider the ethical implications of these widespread and highly varied practices, avoiding any overlap with the research being carried out by other United Nations bodies and agencies. In addition, relations were established with internal and external sources for consultative purposes.

Internally, exchanges took place with the Member States of the Intergovernmental Bioethics Committee (IGBC) at the joint session of IBC and IGBC, and the 7th Session of IGBC, held at UNESCO Headquarters in October 2010 and September 2011 respectively. At IBC’s 17th Session, in October 2010, experts from UNESCO’s Natural Sciences Sector and Culture Sector were also invited to present their points of view on the matter.

Externally, traditional medicine practitioners from different parts of the world were invited by IBC to take part in its 18th Session, held in Baku in May-June 2011, and they enriched the discussion by presenting their own experiences and viewpoints.

A draft version of the report was discussed by IBC members in the first months of 2012. The report was submitted at the 19th Session of IBC, held at UNESCO Headquarters in Paris on 11 and 12 September 2012, so that the possible follow-up to it could be studied. Consequently, based on the comments received during the 19th Session, the Committee revised and finalized the report in January 2013.

This document, which is neither exhaustive nor prescriptive, does not necessarily represent views of UNESCO’s Member States.

UNESCO REPORT OF THE INTERNATIONAL BIOETHICS COMMITTEE ON TRADITIONAL MEDICINE SYSTEMS AND THEIR ETHICAL IMPLICATIONS 2013

Global Health Histories Seminar on Traditional Medicine, 13 March 2013, WHO/HQ

Progress since WHO TM Strategy 2002-2005 (review of the indicators)

25

39 45 48

69 65

82

92

110

119

0

20

40

60

80

100

120

140

1999 2003 2005 2007 2012

Figure 1: Number of MS with TM policy and MS regulating herbal medicines

Number of MS with TM policy Number of MS regulating herbal medicines


Progress since WHO TM Strategy 2002-2005 (review of the indicators)

19

56 58

73

0

10

20

30

40

50

60

70

80

1999 2003 2005 2012

Figure 2: Number of MS with national research institute in TM/CAM


Current situation: regulation on providers

With regulations on T&CM providers

With no regulations on T&CM providers

Not answered

Regulations on T&CM providers Source: country report

56 (43.5%)

56 (43.5%)

17 (13%)

129


Current situation: education

No T&CM education at university level

With T&CM at university level

Not answered

Member States that provide T&CM education at university level Source: country report

18 (14%)

72 (56%)

129


Challenges

15

58

60

63

65

67

68

75

78

83

105

0 20 40 60 80 100 120

Other

Lack of education and training for TM/CAM providers

Lack of mechanisms to monitor safety of TM/CAM products, including herbalmedicines

Lack of cooperation channels between national health authorities to shareinformation about TM/CAM

Lack of mechanisms to monitor safety of TM/CAM practice

Lack of expertise within national health authorities and control agencies

Lack of financial support for research on TM/CAM

Lack of appropriate mechanisms to monitor and regulate TM/CAM providers

Lack of appropriate mechanisms to control and regulate herbal products

Lack of mechanisms to control and regulate TM/CAM advertising and claims

Lack of research data

Number of Member States

Difficulties faced by Member States with regard to regulatory issues related to the practice of T&CM

Source: country report


Requests

11

29

38

45

47

50

51

51

54

54

55

55

58

65

1

49

37

39

37

36

28

32

34

35

29

33

39

29

5

10

12

14

7

11

17

19

17

8

10

9

6

7

0 20 40 60 80 100 120

Other

Provision of guidance on self-care, information for the public in primary health care or at thecommunity level

Provision of cooperation channels between national health authorities

Provision of technical support to promote safe and effective use of indigenous traditionalmedicine in Primary Health Care

Arrangement of global meetings

Provision of guidelines or minimum requirements for basic training of TM/CAM providers

Seminar/workshop about national capacity to establish regulations for herbal medicines

Seminar/workshop on developing national policy and programmes for TM/CAM

Seminar/workshop about national capacity to establish regulations on TM/CAM practice

Provision of research databases

Seminar/workshop about national capacity building on safety monitoring of herbal medicines

Seminar/workshop about integration of TM/CAM in the primary health care context

Information sharing on regulatory issues

General technical guidance for research and evaluation of TM/CAM related to safety, qualityand efficacy

Number of Member States

The type of support for T&CM issues that Member States are interested in receiving from WHO

Source: country report

Great need

Some need

No need


A strategy on T&CM for 2014-23: from recognition to regulation and integration Goals:

z Harness the potential contribution of T&CM to health, wellness and person-centred health care in MS

z Promote safe and effective use of T&CM through regulation, evaluation and integration of products, practitioners and practice

Objectives:

z To build knowledge base to actively manage T&CM through appropriate national policies

z To strengthen the quality, safety and effectiveness of T&CM through regulating products, practice and practitioners

z To promote equitable access to health through appropriate integration of T&CM services in healthcare delivery and self-health care


A strategy on T&CM for 2014-23:

from recognition to regulation and integration

z Support Member States on research of T&CM to build the knowledge for management and policy development: practice profile, modalities, resource preservation

z Support Member States on regulation of T&CM: benchmarks, guidelines, terminologies and networks

z Support Member States on integration of T&CM into health systems: access, service delivery models, classifications, education manuals


Regulation on T&CM

z Regulation on T&CM products

z Regulation on T&CM practice

z Regulation on T&CM practitioners

z Knowledge based, evaluation

z International regulatory collaboration


Timeline

2011: preparation; assemble evidence

2012: drafts and

consultations

2013: finalize draft

and file report to EB

2014: discussed in EB and WHA

Fourth WHO Working Group Meeting on Traditional Medicine Strategy held in Hong Kong April 2013 The World Health Organization (WHO) today (April 24) convened the Fourth Working Group Meeting on Traditional Medicine Strategy in Hong Kong to further discuss and develop the next WHO Traditional Medicine Global Strategy. The three-day meeting, jointly organised by the WHO and Hong Kong's Department of Health (DH), continues to devise the next global strategy in the light of the latest global developments in Traditional Medicine and the challenges that have emerged in the past decade. Addressing the opening ceremony today, the Director of Health, Dr Constance Chan, said, "Traditional Medicine has been, and will continue to be, a precious resource and part of the cultural heritage in many parts of the world. It is our mission to maximise the potential contribution of traditional medicine to the health care system to benefit our people, and our responsibility to ensure this resource is used in a safe, effective and cost-effective manner." "Production of the global strategy at this point in time cannot be more pertinent," she added. Dr Chan said that the Chinese Medicine Division of the DH, which is the designated WHO Collaborating Centre for Traditional Medicine, would continue to support the WHO to advocate and implement the global strategy, and facilitate better collaboration and co-ordination among WHO member states and regions. She also took the opportunity to share with participants some of the recent milestones that mark the Government's strong commitment to the development of Chinese Medicine in Hong Kong. These include the setting up of the Chinese Medicine Development Committee (CMDC) by the Chief Executive early this year to give recommendations to the Government concerning the direction and long-term strategy in the future development of Chinese Medicines in Hong Kong, and the publication of the fifth volume of the Hong Kong Chinese Materia Medica Standards (HKCMMS) in December last year. "The CMDC sets the scene for better integration of Traditional Medicine in the mainstream health care system, contributing to its modernisation and internationalisation, while the HKCMMS with publications up to five volumes so far, covering standards for about 200 commonly used herbs in Hong Kong, is an important step forward to ensure the quality of herbs on sale in the local market," Dr Chan said. Dr Chan expressed her sincere gratitude to the WHO for its leadership in co-ordinating member states and regions in formulating the global strategy, which would shape the future of health care and bring the whole world to new horizons. About 20 international experts from the WHO's six regions, namely Africa, the Americas, South-East Asia, Europe, the Eastern Mediterranean and the Western Pacific, as well as local experts attended the meeting.

h6p://apps.who.int/iris/bitstream/10665/92455/1/9789241506090_eng.pdf

h6p://www.who.int/medicines/publicaMons/tradiMonal/trm_strategy14_23/en/

The WHO Traditional Medicine Strategy 2014–2023 was developed and launched in response to the World Health Assembly Resolution on Traditional Medicine (WHA62.13). The strategy aims to support Member States in developing proactive policies and implementing action plans that will strengthen the role Traditional Medicine plays in keeping populations healthy. Addressing the challenges, responding to the needs identified by Member States and building on the work done under the WHO Traditional Medicine Strategy 2002–2005, the updated strategy for the period 2014–2023 devotes more attention than its predecessor to prioritizing health services and systems, including Traditional and Complementary Medicine products, practices and practitioners.

17

WHO Traditional Medicine Strategy

Evolution of the WHO TM Strategy 2014–2023

This document is intended to provide information, context, guidance and support to policymakers, health service planners, public health specialists, traditional and complementary medicine communities and other interested parties about T&CM, including products, practices and practitioners. It addresses issues in evaluating, regulating and integrating T&CM, as well as in harnessing its potential to benefit the health of individuals. The WHO Traditional Medicine Strategy 2014–2023 updates and enhances the framework for action laid out in:

Q the WHO Traditional Medicine Strategy 2002–2005 (2), the first strategy document ever prepared by WHO in this field;

Q the traditional medicine sections of the WHO Medicines Strategy 2004–2007 (3);

Q and the traditional medicine components of the WHO Medicines Strategy 2008–2013 (4).

This new strategy reviews the potential contribution T&CM can make to health, in particular health service delivery, and establishes priority actions for the period to 2023. This strategy is an effective and proactive response to the World Health Assembly Resolution on traditional medicine (1), which encourages Member States to consider T&CM as an important part of the health system and builds on the work introduced in the Beijing Declaration, adopted by the WHO Congress on Traditional Medicine in 2008.

This new strategy is an important document for Member States, T&CM stakeholders and WHO in positioning T&CM within countries’ health systems. The strategy highlights advances in T&CM research and development and recognizes the experience gained during implementation of the WHO Traditional Medicine Strategy 2002–2005 and the WHO medicines strategies mentioned above.

23

WHO Traditional Medicine Strategy

2.3 Education and research

In order to improve the safe and qualified practice of T&CM, Member States have developed regulations on the quality, quantity, accreditation and education structures for T&CM practitioners, including practitioners of conventional medicine who use T&CM. Significant progress has been made in

1 Communication with WHO from the Government of the Republic of Korea, Ministry of Health and Welfare, 2013.

Figure 3: T&CM education at university level

Source: Interim data from 2nd WHO TRM global survey as of 11 June 2012.

129

With T&CMat university

level

Notanswered

No T&CMeducation at

university level

72(56%)

39(30%)

18(14%)

many. For example, the number of Member States providing high-level T&CM education programmes including Bachelor, Master and Doctoral degrees at university level has increased from only a few to 39, representing 30% of the surveyed countries (Figure 3).In the African Region, TM knowledge and practices have been passed on orally among traditional health practitioners for many generations. In recent years, some countries have strengthened training programmes to develop the knowledge of traditional health practitioners. Furthermore, in some countries TM is included in university curricula for health profession students. For instance, various universities in the Economic Community of West African States, Democratic Republic of Congo, South Africa and Tanzania include TM in the curricula for pharmacy and medical students (8).

To support Member States in moving towards quality training, WHO has published a series of training guidelines and benchmarks (http://apps.who.int/medicinedocs/en/cl/CL10/; see also Annex C).

58

Table 1: Key performance indicators

Strategic objective Strategic direction Expected outcomes Critical indicator

4.1 To build the knowledge base for active management of T&CM through appropriate national policies

4.1.1 Understand and recognize the role and potential of T&CM

��T&CM practices and practitioners identified and analysed by Member State and country profile devised for T&CM.

��T&CM policies and programmes established by government.

��Number of Member States reporting a national/provincial/state T&CM policy.

��Number of Member States reporting increased governmental/public research funding for T&CM;

4.1.2 Strengthen the knowledge base, build evidence and sustain resources

��Strengthened knowledge generation, collaboration and sustainable use of TM resources.

4.2 To strengthen quality assurance, safety, proper use and effectiveness of T&CM by regulating products, practices and practitioners.

4.2.1 Recognize the role and importance of product regulation

��Established and implemented national regulation for T&CM products including registration.

��Strengthened safety monitoring of T&CM products and other T&CM therapies.

��Technical guidelines and methodology developed for evaluating safety, efficacy and quality of T&CM.

��Number of Member States reporting national regulation for T&CM products

��Number of Member States reporting national/provincial/state regulation for T&CM practice

��Number of Member States reporting national/provincial/state regulation/registration for T&CM practitioners

4.2.2 Recognize and develop practice and practitioner regulation for T&CM education and training, skills development, services and therapies

��Standards for T&CM products, practices and practitioners developed by government.

��Established education/training programme, benchmarks and implementation capacities for T&CM practitioners

��Improved safe and effective use of T&CM

4.3 To promote universal health coverage by integrating T&CM services into health care service delivery and self-health care

4.3.1 Capitalize on the potential contribution of T&CM to improve health services and health outcomes.

��Integration of T&CM into the health system.

��Improved T&CM services and accessibility.

��Improved communication between conventional medicine practitioners, professional bodies and T&CM practitioners concerning the use of T&CM.

��Number of Member States reporting national plan/programme/approaches for integrating T&CM service into the national health service delivery

��Number of Member States reporting consumer education project/programme for self-health care using T&CM

4.3.2 Ensure consumers of T&CM can make informed choices about self-health care.

��Better awareness of and access to information about the proper use of T&CM.

��Improved communication between conventional medicine practitioners and their patients about T&CM use.

Implementing the Strategy

26/11/13 08:12OMS: la strategia per le Medicine Tradizionali del futuro

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OMS: la strategia per le Medicine Tradizionali del futuroOMS: la strategia per le Medicine Tradizionali del futuro

Pubblichiamo (vedi allegato) il "World Health Organization TraditionalMedicine Strategy 2014-2023", documento che riguarda la strategiadell'Organizzazione Mondiale della Sanità per le Medicine Tradizionali per ilperiodo 2014-2023.

A tal proposito, si ricorda che Paolo Roberti di Sarsina è l'unico ricercatoreitaliano citato nelle referenze bibliografiche utilizzate dal gruppo di lavorodell'OMS per redigere il documento.

a cura di Redazione FNOMCeO Web

Articolo pubblicato in: News

Documenti allegati:

WHO Traditional Medicine Strategy 2014-2023

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FNOMCeOFNOMCeOFederazione Nazionale degli Ordini dei Medici Chirurghi e degli OdontoiatriFederazione Nazionale degli Ordini dei Medici Chirurghi e degli Odontoiatri

HOME NOTIZIE CONTATTI

FEDERAZIONE COMUNICATI EVENTI PRIMO PIANO RICERCA ANAGRAFICA

EUROPEAN PARLIAMENT (1997)

Resolution n. 75

“On the Status of Non-Conventional Medicine”

Bruxelles, 29.05.1997

COUNCIL OF EUROPE (1999)

Resolution n. 1206

“A European approach to Non-Conventional Medicine”

Bruxelles, 04.11.1999

CAM is a variety of different medical systems and healthcare methods, which roots come from the European culture or reflect different philosophical backgrounds and cultural origins, based on the knowledge, skills and prac&ces used to protect and to restore health, that is to prevent, diagnose, improve or treat physical or mental illness and include medica&on therapies and non-‐medica&on therapies. A dis&nc&ve feature common to these health knowledges is a holis&c, person-‐centred, spiritual, inclusive, approach. In countries where the dominant health care system is based on biomedicine or allopathic medicine these health and healing knowledges are not included into the na&onal health care system being considered unconven&onal medicine. (Paolo RoberK di Sarsina, definiKon proposed to the European (FP7) CAMbrella Consor&um, 2012)

Use of Traditional and Non-Conventional Medicine in Italy 1996-2012 (updated from Roberti di Sarsina P, Iseppato I. (2011) EPMA Journal, 2(4):439-449.

ISTAT (1996-99) 9 million Italians use NCM (15.5%)

ABACUS (2003) 30% of Italians are familiar with the term Non-Conventional Medicine

DOXA (2003) 23% of the population use NCM

ISPO (2003) 65% of the population are familiar with the term Non-Conventional Medicine and know something about it

FORMAT (2003) 31.7% of Italians have used NCM at least once; 23.4% use NCM regularly

CENSIS (2003) 50% think NCM useful; over 70% claim it should be passed by the National Health Service; 65% would like more monitoring by the national health authorities

Menniti-Ippolito et al. (2004)

3-year follow-up on 52,332 families (140,011 persons): 15.6% use NCM (homeopathy 8.2%, manual therapy 7%, phytotherapy 4.8%, acupuncture 2.9%, other NCMs 1.3%)

ISTAT (2005) 8 million Italians use NCM (13.6% of the population) EURISPES (Rapporto Italia 2006) 10.6% of the population choose NCM

Osservatorio Scienza Tecnologia e Società, Centro Ricerche Observa-Science in Society, Nova Il Sole 24 Ore 24 07.12.2006

One Italian out of three adopted, at least occasionally, homeopathic medicinal products to cure and treat illnesses.

CENSIS (2008) 23.4% had adopted to TM/NCM medication therapies and non-medication therapies in the previous year (especially homeopathy and phytotherapy)

EURISPES (Rapporto Italia 2010) more than 11 million opt for NCM medication therapies and non-medication therapies, i.e. 18.5% of the population

Health Monitor CompuGroup Medical-Il Sole 24 Ore Sanità (2011)

about 52% of general practitioners suggests homeopathic therapies to patients.

EURISPES (Rapporto Italia 2012) 14,5% of the population adopt NCM

Doxapharma (2012) 82,5% declare to have been informed about homeopathic medicinal products; 16,2% adopted, at least once in the year, homeopathic medicinal products.

!

EURISPES Rapporto Italia 2012

Ricorso alla medicina convenzionale (83,5%) Ricorso alla medicina non convenzionale (14,5%)

RispeDo alla rilevazione di due anni prima quest’ulKmo dato registra una contrazione (-‐4%)

•  Homeopathy (70,6%) •  Phytotherapy (39,2%) •  Osteopathy (21,5%) •  Acupuncture (21%) •  ChiropraKcKc (17,2%) •  Ayurvedic Medicine (8,9%) •  Homotoxicology (6,4%) •  Antroposophic Medicine (5,1%) •  TradiKonal Chinese Medicine (3,8%)

Widening the Paradigm in Medicine and Health:Person-Centred Medicine as the CommonGround of Traditional, Complementary,Alternative and Non-Conventional Medicine

Paolo Roberti di Sarsina, Mauro Alivia, and Paola Guadagni

Contents

1 The Need for Person-Centred Medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3362 The Need for Salutogenesis in Healthcare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3373 TCAM Systems as Person-Centred and Salutogenetic Medical Systems . . . . . . . . . . . . . . . . . . . 3384 The Current Situation of TCAM in Europe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 340

4.1 The CAMbrella Consortium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3424.2 Prevalence of TCAM in Europe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 344

5 Widening the Paradigm in Health and Medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3455.1 Implications for Healthcare Professionals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3465.2 Implications for Patients and Citizens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3485.3 Implications for Society and Healthcare Systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 349

6 Steps Towards Widening the Paradigm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 350References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 351

Abstract This chapter outlines the paradigm of person-centred medicine and itscontribution to the growing pluralism of medical science. It adds to the paradigm ofpersonalised medicine. It is characterised by a holistic approach, which stems fromthe demands of patients for a greater humanisation of medicine, individualisationof treatments and autonomy in the choice of therapeutic processes. It finds fertile

P. Roberti di Sarsina (!)Ministry of Health, Rome, Italy

Charity Association for Person-Centred Medicine, Bologna, Italy

Observatory and Methods for Health, University of Milano-Bicocca, Via Siepelunga, 36/12,40141 Bologna, Italye-mail: [email protected];[email protected]

M. Alivia • P. GuadagniCharity Association for Person-Centred Medicine, Bologna, Italy

Italian Society of Anthroposophic Medicine (SIMA), Milano, Italye-mail: [email protected]; [email protected]

V. Costigliola (ed.), Healthcare Overview: New Perspectives, Advances in Predictive,Preventive and Personalised Medicine 1, DOI 10.1007/978-94-007-4602-2 18,© Springer ScienceCBusiness Media Dordrecht 2012

335

REVIEW Open Access

Traditional, complementary and alternativemedical systems and their contribution topersonalisation, prediction and prevention inmedicine—person-centred medicinePaolo Roberti di Sarsina1,2,3*, Mauro Alivia2,4 and Paola Guadagni2,4

Abstract

Traditional, complementary and alternative medical (TCAM) systems contribute to the foundation of person-centredmedicine (PCM), an epistemological orientation for medical science which places the person as a physical,psychological and spiritual entity at the centre of health care and of the therapeutic process. PCM wishes tobroaden the bio-molecular reductionistic approach of medical science towards an integration that allows people,doctors, nurses, health-care professionals and patients to become the real protagonists of the health-care scene.The doctor or caregiver needs to act out of empathy to meet the unique value of each human being, whichunfolds over the course of a lifetime from conception to natural death. Knowledge of the human being should notbe instrumental to economic or political interests, ideology, theories or religious dogma. Research needs to bebroadened with methodological tools to investigate person-centred medical interventions. Salutogenesis is afundamental principle of PCM, promoting health and preventing illness by strengthening the individual'sself-healing abilities. TCAM systems also give tools to predict the insurgence of illness and treat it before theappearance of overt organic disease. A task of PCM is to educate people to take better care of their physical,psychological and spiritual health. Health-care education needs to be broadened to give doctors and health-careworkers of the future the tools to act in innovative and highly differentiated ways, always guided by deep respectfor individual autonomy, personal culture, religion and beliefs.

Keywords: Traditional, Complementary and alternative medicine, Biomedicine, Person-centred medicine,Personalised medicine, Prediction, Prevention, Salutogenesis, Health-care reform, Health-care education, Therapeuticrelationship

ReviewThe need for person-centred medicinePatients themselves demand an improvement in thequality of medical interventions with greater humanisa-tion, personalisation of treatments and adequate infor-mation received in a safe environment to be able tomake choices about their therapeutic process freely [1].They want a doctor who will talk to them, listen to whatthey say and give them advice about how to get better

and protect their health in the future. They want to begiven the time and the space to express during the con-sultation, and once a therapeutic relationship is estab-lished, they wish to continue seeing the same person togive continuity to the process of healing. In many cases,the wish for a prescription is secondary to the wish ofbeing cared for [2].Many doctors and caregivers already practise person-

centred medicine (PCM) with growing interest from col-leagues and institutions. There is a perceived need tocreate a more satisfying therapeutic relationship, indivi-dualising treatments beyond clinical guidelines to suitthe whole person in the context of his or her bio-psycho-spiritual biography [3]. PCM takes on the task to

* Correspondence: [email protected] Council of Health, Ministry of Health, Rome 00144, Italy2Charity Association for Person Centred Medicine, Via Siepelunga, 36/12,Bologna 40141, ItalyFull list of author information is available at the end of the article

© 2012 Roberti di Sarsina et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of theCreative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use,distribution, and reproduction in any medium, provided the original work is properly cited.

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Review Retinitis pigmentosa and ocular blood flowKatarzyna Konieczka, Andreas J Flammer, Margarita Todorova, Peter Meyer, Josef FlammerEPMA Journal 2012, 3:17 (3 December 2012)

Review Introduction into PPPM as a new paradigm of public health service: an integrative viewTatiana A Bodrova, Dmitry S Kostyushev, Elena N Antonova, Shimon Slavin, Dmitry A Gnatenko, Maria O Bocharova, Michael Legg, Paolo Pozzilli, Mikhail APaltsev, Sergey V SuchkovEPMA Journal 2012, 3:16 (9 November 2012)

Review Traditional, complementary and alternative medical systems and their contribution to personalisation, prediction and prevention in medicine—person-centred medicinePaolo Roberti di Sarsina, Mauro Alivia, Paola GuadagniEPMA Journal 2012, 3:15 (6 November 2012)

Report General Report & Recommendations in Predictive, Preventive and Personalised Medicine 2012: White Paper of the European Association forPredictive, Preventive and Personalised MedicineOlga Golubnitschaja, Vincenzo Costigliola, EPMAEPMA Journal 2012, 3:14 (1 November 2012)

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Review Behavior, nutrition and lifestyle in a comprehensive health and disease paradigm: skills and knowledge for a predictive, preventive andpersonalized medicineGuglielmo M TrovatoEPMA Journal 2012, 3:8 (22 March 2012)

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eCAM 2007;4(S1)45–51doi:10.1093/ecam/nem094

Original Article

The Social Demand for a Medicine Focused on the Person:The Contribution of CAM to Healthcare and Healthgenesis

Paolo Roberti di Sarsina MD

Expert for Non Conventional Medicines, Italian National Council for Health, Ministry of Health, Rome. CoordinatorCommittee for CAM in Italy. Department of Mental Health, Health Local Unit, Bologna, Italy

The Non Conventional Medicines have a greater social impact and the demand for suchtreatments of more than 10 million Italian citizens (male and female) of all ages and socialclasses and of thousands of Italian families reveals an interest proving that there is a trendreversal, involving also other sectors of the medical and scientific world, which shifts the focusfrom the symptom to an idea of more general and comprehensive well-being of the person.Over the last few years the scientific debate on Non Conventional Medicines and theirintegration with the academic or dominant medicine in our western society has favored andlegitimated an increase in the demand and has activated a cultural transformation processinvolving the life styles. The focus is therefore shifted to the self-healing capacities, to thereawakening of the individual potentialities, which support and amplify the benefits of thetreatments and the citizens start pretending to be accurately informed in order to choose freelytheir own health program.

Keywords: healthgenesis – medicine focused on the person – non conventional medicines

Introduction

The definition of CAM, relative to statements ofNCCAM and WHO, points out that ‘unconventional’,although the most common expression used in Italy,would seem to place these treatment methods in contrastwith academic medicine, considered as conventional.In the English-speaking world the term CAM(Complementary and Alternative Medicine) is used, andit is crucial to underline the complementary nature ofdifferent possible diagnostic and therapeutic approachesthat fit here in order to emphasize the integration whichis currently in the health system and the possibility of thepractical use of all the information provided by thepatient. Concepts like healthcare strictly connected withthat of healthgenesis are introduced together with dataconcerning CAM in the western world thus focusing onthe present situation of Non Conventional Medicines/

CAM in Italy. ‘Medicine Focused On The Person’ resultsfrom the need of every patient and client. The importanceof being treated with dignity and respect is every person’sright, improving patient’s experience of care, reducinginequalities, being well aware of the ‘health socialgradient’ with regards to sustainable balance andpharmacoeconomy in order to encourage change in thethought processes of Health Policy, particularly towardsthose developing national health care strategies. The term‘Medicine Focused On The Person’ in terms of sustain-ability clearly includes, the sense of Integrative Medicineas a synergistic and harmonious blend of conventionaland complementary medicine, within a safe environmentbut looks open to future developments. The results ofnumerous surveys on health care quality carried out inthe USA, in Europe and more recently in Italy show that,if a patient is asked to assess the quality of the medicaltreatments, his/her priorities are: humanization, tailoringof the treatments, the need of attention from PublicInstitutions and adequate information in a comfortableenvironment for a free choice of the individual health

For reprints and all correspondence: Paolo Roberti di Sarsina, MD,Via Siepelunga 36/12 40141 Bologna, Italy. Tel: +39-3358029638;E-mail: [email protected]

! 2007 The Author(s).This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/2.0/uk/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work isproperly cited.

Review

Looking for a Person-centered Medicine: Non ConventionalMedicine in the Conventional European and Italian Setting

Paolo Roberti di Sarsina1 and Ilaria Iseppato2

1Italian High Council of Health, Ministry of Health, Rome, Italy and 2Department of Sociology, University ofBologna, Bologna, Italy

In Italy, the use of non conventional medicines (NCMs) is spreading among people as in therest of Europe. Sales of alternative remedies are growing, and likewise the number of medicaldoctors (MDs) who practise NCM/complementary and alternative medicine (CAM). However,in Italy as in other countries of the European Union, at the present time the juridical/legalstatus of NCM/CAM is not well established, mainly due to the lack of any national lawregulating NCM/CAM professional training, practice and public supply and the absence ofgovernment-promoted scientific research in this field. This is an obstacle to safeguarding thepatient’s interests and freedom of choice, especially now that dissatisfaction with biomedicine isinclining more and more people to look for a holistic and patient-centered form of medicine.

Keywords: Non conventional medicines (NCMs) – complementary and alternative medicine(CAM) – person-centred medicine – NCM/CAM legal status

Introduction

In western societies, people generally confuse the terms‘medicine’, ‘biomedicine’, ‘evidence-based medicine’ and‘allopathic’, using them as synonyms. Though the neolo-gism ‘biomedicine’ appeared as early as 1923 in Dorland’sMedical Dictionary (1)—defined as ‘clinical medicinebased on the principles of physiology and biochemis-try’—neither this nor other specific hybrid meaningswere much heard of before the 1960s when the USNational Institutes of Health (NIH) introduced theterm to justify its diversion of funds into molecularbiology. ‘Medicine’ proper is actually something morecomprehensive, a holistic concept that includes ‘biomedi-cine’, but also all other philosophical/anthropologicalapproaches to managing health, illness and disease.Amid the prevailing confusion, western biomedical cul-ture tends in its turn to define ‘alternative medicine’ ina negative way, as something outside the mainstream,

unsupported by scientific explanation or academylegitimization (2).

The National Center for Complementary andAlternative Medicine

The National Center for Complementary and AlternativeMedicine (NCCAM) of the US NIH defines CAM as abroad domain of healing resource that encompasses allhealth systems, practices and beliefs, other than thoseintrinsic to the politically dominant health system in aparticular society at a given historical period. The mainlimitation of this definition is mixing alternative medicineand complementary practices in one single category.CAM has been defined as therapeutic intervention thathas neither been widely established for use in conven-tional healthcare practice nor incorporated into the stan-dard medical curriculum. The NCCAM characterizesCAM therapies into five categories: biologically basedtherapies, manipulative- and body-based therapies, energymedicine, mind–body medicine and whole medical systems.In contrast, we have the definition of traditional medicine

For reprints and all correspondence: Paolo Roberti di Sarsina, MD,Italian High Council of Health, Ministry of Health, Rome, Italy.Tel: +39-3358029638; E-mail: [email protected]

eCAM 2009;Page 1 of 8doi:10.1093/ecam/nep048

! The Author 2009. Published by Oxford University Press. All rights reserved. For permissions, please email: [email protected]

eCAM Advance Access published June 8, 2009

European Journal of Integrative Medicine 1 (2009) 65–71

Review article

Non-Conventional Medicine in Italy: The present situation

Paolo Roberti di Sarsinaa,!, Ilaria Iseppatob

aItalian High Council of Health, Ministry of Health, Rome, ItalybDepartment of Sociology, University of Bologna, Italy

Received 26 March 2009; received in revised form 19 April 2009; accepted 29 April 2009

Abstract

This article provides a brief overview of the current situation in Italy regarding the diffusion and regulation of Non-ConventionalMedicine (NCM). In Italy the use of NCM is spreading among the population as in the rest of Europe. Sales of alternative remedies aregrowing, and likewise the number of MDs who practice NCM. However, in Italy, unlike in other countries of the European Union, at thepresent time the juridical/legal status of NCM is not well established, mainly due to the lack of any national law regulating NCMprofessional training, practice and public delivery, not to mention the absence of government-promoted scientific research in this field.After procrastinating for 20 years, the Italian Parliament is therefore urged to legislate without further delay and approve a full-scalenational law on Non-Conventional Medicine to protect citizens’ safety and freedom of choice.r 2009 Elsevier GmbH. All rights reserved.

Keywords: Non-Conventional Medicine (NCM); Complementary and Alternative Medicine (CAM); NCM legal status; Italian healthcare system

Epistemological bearings: Why we prefer talking about Non-Conventional Medicine

For years the World Health Organization has definedNon-Conventional Medicine (NCM) as ‘‘Traditional Med-icine’’ in deference to the nations and cultures where suchforms of medicine are an integral part of the cultural andmedical heritage (for instance, China’s and India’s culturaltraditions) [1]. Traditional Medicine is the sum total ofindigenous knowledge used in the maintenance of health inthese countries; however, wrongly, in Western countries theterms ‘‘Traditional Medicine’’ and ‘‘Non-ConventionalMedicine’’ are often used interchangeably. So, paradoxi-cally, in Western countries indigenous biomedicine andalternative medicine may come to coincide.

The term adopted by the Cochrane Collaboration andby international literature is ‘‘Complementary and Alter-native Medicine’’ (Consensus Conference, United StatesOffice for Alternative Medicine of the National Institutes

of Health, Bethesda, USA, 1997). The multi-dimensionalmeaning of this definition is immediately obvious: it appliesat the same time to both exclusively first-choice treatment(alternative medicine) and second-choice or associatedtherapy approaches (complementary medicine) [2]. More-over, Western biomedical culture usually tends to identify‘‘alternative medicine’’ in a negative way, as somethingoutside the mainstream, unsupported by scientific explana-tion or academic legitimization [3].For the reasons stated above, we chose to keep the term

‘‘Non-Conventional Medicine’’, which is generally sociallymore widespread, better known and understood in Italianparlance, as well as already employed by the (FNOMCeO(National Council of the Italian National Federation ofColleges of MDs and Dentists) in the Terni Document(2002)) [4], by the European Parliament (1997), by theCouncil of Europe (1999) and in the Consensus Documenton NCM in Italy (2003).The Italian sociologist of health Guido Giarelli clarifies

this epistemological point in unmistakable terms as regardsthe Italian scene: ‘‘Non Conventional Medicine is thedefinition we prefer and have chosen to keep in the currentItalian situation, for at least three reasons: it seems as littleladen as possible with positive or negative ideological

ARTICLE IN PRESS

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1876-3820/$ - see front matter r 2009 Elsevier GmbH. All rights reserved.doi:10.1016/j.eujim.2009.04.002

!Corresponding author. MD, Expert for Non Conventional MedicineItalian High Council of Health, Ministry of Health, Rome, Italy.Tel.: +39335 8029638; fax: +39 051 442039.

E-mail address: [email protected] (P. Roberti di Sarsina).

Letter to the Editors · Brief an die Herausgeber

Forsch Komplementmed 2010;17:277–278 Published online: September 9, 2010

DOI: 10.1159/000320603

Paolo Roberti di Sarsina, MDVia Siepelunga 36/12 40141 Bologna, ItalyTel. +39 335 8029638, Fax [email protected]

© 2010 S. Karger GmbH, Freiburg

Accessible online at: www.karger.com/fok

Fax +49 761 4 52 07 [email protected]

Person-Centred Medicine: Towards a DefinitionPaolo Roberti di Sarsinaa Ilaria Iseppatob

a Italian High Council of Health, Ministry of Health, Rome, b University of Bologna, Italy

The history of the relationship between Complementary and Alternative Medicine (CAM) and mainstream health care has shifted from the early days of pluralism, through hostility and exclusion, to one of grudging acceptance. The current situa-tion is characterised by a tacit acknowledgement and in some cases opens endorsement by biomedicine for a number of forms of CAM practice, largely driven by the popularity of CAM to consumers in our increasingly market-driven health care system both on the practice of CAM and biomedicine, and on the health care choices available to consumers [1].

Person-centred medicine lies at the interface of biomedi-cine and traditional, complementary and alternative medicine (TM/CAM) or non-conventional medicine (NCM). Concepts like health care strictly connected with that of health genesis are introduced together with data concerning CAM/NCM in the Western world [2]. The term ‘person-centred medicine’ in terms of sustainability clearly includes the sense of NCM/CAM as a synergistic and harmonious blend of conventional and complementary medicine, but looks open to future devel-opments. The results of numerous surveys on health care quality carried out in the USA and in Europe show that, if a patient is asked to assess the quality of the medical treat-ments, his/her priorities are: humanization, tailoring of the treatments, the need of attention from public institutions and adequate information in a comfortable environment for a free choice of the individual health programme. However, despite WHO’s definition of health, the attitudes and practice of much of modern medicine have become profoundly disease focused and organ specific with ever increasing specialization. The limitations of disease-specific approaches in the context of the growing prevalence of co-morbidity are becoming more obvious. Humanistic behaviour is considered an essential component of professional medical care. However, the evi-dence shows that it is often neglected. Many barriers to the expression of sensitivity to the patient’s concerns, empathy, and compassion in the clinical encounter can be identified. Time constraints, poor continuity of care, appearance of al-

ienating factors between patients and physicians, and the ‘hid-den curriculum’ are just a few in a long list [3].

Person-centred medicine is a humanistic and at the same time evidence-based approach. For all human beings the es-sence of diagnosis and therapy is that they be tailored to the intrinsic unity of man’s physical and mental nature. This is fundamental to the healing process. Person-centred medicine allows for that individual psycho-physical equilibrium which is, and will be, the basis for any sustainable equilibrium in so-ciety at present or in the future. Person-centred medicine calls for wider medical knowledge and practice, not only of how to treat pathology but how to generate health (health-genesis). It is a systemic approach, not mechanistic or reductive. It typi-cally adopts a unitary view of sentient being and the world; it values the complexity of natural phenomena; it studies the relations of man to his environment, how body and psyche interact, what spiritual integrity means in a human being; and stresses active patient responsibility for keeping healthy or being healed.

In the middle of the doctor-patient relationship under this person-centred approach lies the patient’s own ‘narration’. This narration is part and parcel of how the patient ‘makes sense’ across the spectrum of his/her bio-psycho-spiritual exist-ence. Person-centred medicine entails total a priori acknowl-edgement of and respect for each individual’s dignity – hence physical, psychological, and spiritual suffering. Person-centred medicine at this point becomes anthropological medicine. The development of appropriate and effective therapeutic strate-gies entails a negotiated understanding between the culture of biomedicine, within which health care providers work, and the patient’s cultural experience of illness.

At a time of increasing emphasis on regulating health care and restraining expenditures, this person-centred approach would better equip patients to make informed decisions. For discretionary tests and procedures, complete information about expected benefits and risks may lead many individuals to choose alternative strategies or to be more confident in the

277_278_06002_iseppato.indd 277 18.10.10 16:02

The

Journal International Reviews in Predictive, Preventive & Personalised Medicine (PPPM)

The EPMA Journal Volume 2 • Number 4 • 2011

EDITORIAL

European strategies in predictive, preventive and personalised medicine: highlights of the EPMA World Congress 2011 0. Golubnitschaja · V. Costigliola 315

REVIEW ARTICLES

Mobility of medical doctors in cross-border healthcare V. Costigliola 333

Perpetual transitions in Romanian healthcare l. Spiru ·R.I. ·I. Turcu · M. Marzan 341

Recommendations for the prevention of breast cancer in shift workers K. Richter · J. Acker· N. Kamcev · S. Bajraktarov · A. Piehl · G. Niklewski 351

The need for higher education in the sociology of traditional and non-conventional medicine in Italy: towards a person-centered medicine P. Roberti di Sarsina · M. Tognetti Bordogna 357

Main effects of sleep disorders related to shift work-opportunities for preventive programs S. Bajraktarov ·A. Novotni · N. Manusheva · D.G. Nikovska · E. Miceva-Velickovska · N. Zdraveska · V.C. Samardjiska · K.S. Richter 365

Present and future of secondary prevention after an acute coronary syndrome P.-F. Keller · S. Carballo· D. Carballo 371

Towards salutogenesis in the development of personalised and preventive healthcare M. Alivia · P. Guadagni · P. Roberti di Sarsina 381

Tibetan medicine: a unique heritage of person-centered medicine P. Roberti di Sarsina · L. Ottaviani · J. Mella 385

Forms of antipsychotic therapy: improved individual outcomes under personalised treatment of schizophrenia focused on depression Z. Babinkostova · B. Stefanovski 391

Magnetic resonance imaging and spectroscopy: how useful is it for prediction and prognosis? B. Condon 403

Regional Health Systems and non-conventional medicine: the situation in Italy M.T. Bordogna 411

Prospective care of heart failure in Japan: lessons from CHART studies N. Shiba · H. Shimokawa 425

Traditional and non-conventional medicines: the socio-anthropological and bioethical paradigms for person-centred medicine, the Italian context P. Roberti di Sarsina · I. lseppato 439

Idiopathic REM sleep behavior disorder as a long-term predictor of neurodegenerative disorders S. Fulda 451

Salutogenesis and Ayurveda: indications for public health management A. Morandi · C. Tosto · P. Roberti di Sarsina · D. Dalla Libera 459

Indexed in SCOPUS, EM BASE, Google Scholar, Academic Onefile, OCLC, Summon by Serial Solutions

Instructions for Authors for EPMA are available at http:/ /www.springer.com/biomed/journal/ 13167

REVIEW ARTICLE

The need for higher education in the sociology of traditionaland non-conventional medicine in Italy: towardsa person-centered medicine

Paolo Roberti di Sarsina & Mara Tognetti Bordogna

Received: 22 May 2011 /Accepted: 19 July 2011 /Published online: 12 August 2011# European Association for Predictive, Preventive and Personalised Medicine 2011

Abstract Italy is being forced to re-think her health plan as thenational health service moves towards regional systems,individuals take more active responsibility for their health, thedemand grows for traditional and non-conventional medicineand immigrants join the user list. Person-centered medicine andever-wider skills attainable with the tools of analysis andresearch have made a new professional update indispensable.The proposed Master-Course on “Health systems, traditionaland non-conventional medicine”, first of its kind in Italy, fitsthis bill. The new forms of treatment that state and internationalbodies are prepared to recognize depend entirely on theuniversities training our professionals with concrete skills inplanning, research and healthmanagement. Our paper performsan epistemological critique of the new health requirements andgoes on to outline the reasons behind this training imperative.

Keywords National health system . Regional healthsystems . Traditional medicine . Non-conventionalmedicine . Person-centered medicine . Personalizedmedicine

The world’s various health systems show two currenttrends: a steady alignment as to practice and procedure,with slow but constant regionalization and decentralization;and increasing resort to traditional and non-conventionalmedicine. These processes call for specific skills if they areto be effectively adjusted to, especially on the part of topmanagement and decision-makers.

The need for constantly updated knowledge is due not justto changing organizational and operative patterns withinhealth services, but to new chronic and crippling diseasesand pandemics calling for specific know-how on the part ofnational health services and their welfare networks, plusknowledge of how world health systems work and the healthand prevention measures currently being taken.

Another factor that challenges us to upgrade ourunderstanding is that the end-user is often new, and usedto different health systems (immigrants). Add to this thatpeople are increasingly insisting on choose their treatmentand style of health practice for themselves, beginning withtraditional and non-conventional medicines [1–3].

Acquisition of this know-how is also a challenge toveterinary medicine and especially organic zootechnics. Con-trols on commercially-bred animals and foodstuffs of animalorigin involve the public veterinary service and immediatelyaffect consumer health as well as eco-sustainable animal raisingin conditions that protect biodiversity.

We urgently need the tools to understand the changesafoot in society and its health systems and agriculturalprocesses; and our knowledge must translate into healthcare

Both authors contributed equally: P. Roberti di Sarsina, Coordinator andM. Tognetti Bordogna, Director of Master-course on “Health Systems,Traditional and Non Conventional Medicine”, University of Milano-Bicocca, Italy

P. Roberti di SarsinaExpert for Non Conventional Medicine, High Council of Health,Ministry of Health,Rome, Italy

P. Roberti di Sarsina :M. Tognetti BordognaObservatory and Methods for Health, Department of Sociologyand Social Research, University of Milano-Bicocca,Milano, Italy

P. Roberti di SarsinaCharity “Association for Person-Centered Medicine”,Bologna, Italy

P. Roberti di Sarsina (*)Via Siepelunga, 36/12,40141 Bologna, Italye-mail: [email protected]

EPMA Journal (2011) 2:357–363DOI 10.1007/s13167-011-0102-1

REVIEW ARTICLE

Towards salutogenesis in the development of personalisedand preventive healthcare

Mauro Alivia & Paola Guadagni &Paolo Roberti di Sarsina

Received: 1 August 2011 /Accepted: 13 October 2011 /Published online: 8 November 2011# European Association for Predictive, Preventive and Personalised Medicine 2011

Abstract The purpose of this review is to discuss how asalutogenetic approach that takes into consideration thehuman being as physical, psychological and spiritual entitymay provide some answers to the difficulties faced byhealthcare systems. The choice of medical interventionneeds to take into account the technological advances ofbiomedicine but tailor them to the physical, psychologicaland spiritual needs of the patient in the context of theirbiography. Such person-centred medicine aims to strengthenAntonovsky’s concepts of resilience and sense of coherencewith each therapeutic intervention so that overcoming illnessbecomes the foundation for better future health. Appropriateevaluation parameters need to be developed and included inorder to evaluate the success of interventions in a person-centred, salutogenetic system.

Keywords Personalised medicine . Preventive medicine .

Person-centred medicine . Salutogenesis . Non-conventionalmedicine

Salutogenetic healthcare

Illness is a challenge to our physical, psychological andspiritual wellbeing that has repercussions on our identityand our social context. In a pathogenetic approach,diagnostic tests are used to look for the underlying diseaseand treatments are aimed at removing it. A person isconsidered cured when the disease is no longer detectableand agreed parameters have normalised. However dailyclinical practice is characterised by people who suffer fromchronic illness where there is often a discrepancy betweentheir biochemical results and the way they feel. Good oreven normal parameters do not necessarily correlate with agood perceived state of health, and vice versa. Health istherefore a concept that goes beyond the absence of diseaseto include physical, mental and social wellbeing [1].Salutogenesis, developed by Antonovsky in the 1970s,looks at what generates health by exploring the reasonswhy some people stay healthy in the face of hazardousinfluences whilst others, faced with the same hardship fallill. Antonovsky’s research shows how adverse events andstress can become the opportunity to generate health ifcertain personal characteristics are present. Resilience todifficult situations depends on a person’s Sense ofCoherence (SOC), a global orientation towards life that isbased on self-reliance in the face of challenges, self-confidence in one’s ability to deal with demanding eventsand the trust that difficult events hold meaning for one’s life[2, 3]. There is a growing body of research on all agegroups [4–6], different socioeconomic backgrounds andacross cultures [7] that shows how a strong SOC is relatedto better health, healthier ageing [8–12] and is a protectivefactor against alcohol addiction despite similar rates ofrecreational consumption in teenagers [13]. Conversely, aweak SOC is related to poorer health and lower mood

M. AliviaPast President Italian Society of Antroposophic Medicine (SIMA),Milan, Italy

M. Alivia : P. Guadagni : P. Roberti di SarsinaCharity “Association for Person Centred Medicine”,Bologna, Italy

P. Roberti di SarsinaExpert for non-conventional medicine, High Council of Health,Ministry of Health,Rome, Italy

M. Alivia (*)Corso di Porta Romana 118,20122 Milano, Italye-mail: [email protected]


REVIEW ARTICLE

Tibetanmedicine: a unique heritage of person-centeredmedicine

Paolo Roberti di Sarsina & Luigi Ottaviani & Joey Mella


Abstract With a history going back approximately2,500 years, the Tibetan medicine, known as Sowa Rigpa inthe Tibetan language, is one of the world’s oldest knowntraditional medicine. It originally developed during the pre-Buddhist era in the kingdom known as Shang Shung. As atraditional medicine, the future development of Tibetanmedicine in Western countries is linked to being recognizedas a popular and viable healthcare option providing analternative clinical reality. Its inherent ability to incorparatepredictive diagnostics, targeted prevention, and the creation of

individualized medical treatment give Tibetan medicine greatpotential for assessing and treating patients.

Keywords Tibetan medicine . Sowa Rigpa . ChögyalNamkhai Norbu . Predictive diagnosis . Targetedprevention . Individualized treatment

Introduction

Tibetan medicine is an intricate medicine with a longhistory of treatment effectiveness. As this medicine beginsto spread globally, as with Chinese, Indian Ayurvedic, andother traditional healing modalities, it is important toaccurately inform as large an audience to its salientfeatures. Primarily through alliance and collaboration withWestern MDs, Tibetan medicine can express its principlesin a clear and beneficial way. This would develop throughdialogue, research, and ultimately the sharing of intellectualresources. This article is intended as a brief survey ofTibetan medicine’s ancient history, its development into thepresent, and an exploration into future collaborations. Uponreview it can be seen that Tibetan medicine is an excellentexample of personalized and preventive medicine.

History of Tibetan medicine

Aspects of Tibetan medicine can be found in ancient cultures asold as 2,500 years. It was in the Kingdom of Shang Shung thatpractitioners of the Bön Shamanistic religion recorded formaltexts describing healing rituals, medical divination, andastrology. Practices such as medical divination lead to muchthe same nature of treatment. A divination would be madeindicating a particular elemental disturbance and a ritual

P. Roberti di SarsinaExpert for Non-conventional medicine, High Council of Health,Ministry of Health,Rome, Italy

P. Roberti di SarsinaObservatory and Methods for Health,Universtity of Milano-Bicocca,Milano, Italy

P. Roberti di SarsinaCharity “Association for Person Centred Medicine”,Bologna, Italy

P. Roberti di Sarsina (*)Via Siepelunga 36/12,40141 Bologna, Italye-mail: [email protected]

L. OttavianiInternational Shang Shung Institute for Tibetan Studies,Arcidosso, Italy

J. MellaShang Shung Institute,Conway, USA

EPMA Journal (2011) 2:385–389DOI 10.1007/s13167-011-0130-x

REVIEW ARTICLE

Tibetanmedicine: a unique heritage of person-centeredmedicine

Paolo Roberti di Sarsina & Luigi Ottaviani & Joey Mella


Abstract With a history going back approximately2,500 years, the Tibetan medicine, known as Sowa Rigpa inthe Tibetan language, is one of the world’s oldest knowntraditional medicine. It originally developed during the pre-Buddhist era in the kingdom known as Shang Shung. As atraditional medicine, the future development of Tibetanmedicine in Western countries is linked to being recognizedas a popular and viable healthcare option providing analternative clinical reality. Its inherent ability to incorparatepredictive diagnostics, targeted prevention, and the creation of

individualized medical treatment give Tibetan medicine greatpotential for assessing and treating patients.

Keywords Tibetan medicine . Sowa Rigpa . ChögyalNamkhai Norbu . Predictive diagnosis . Targetedprevention . Individualized treatment

Introduction

Tibetan medicine is an intricate medicine with a longhistory of treatment effectiveness. As this medicine beginsto spread globally, as with Chinese, Indian Ayurvedic, andother traditional healing modalities, it is important toaccurately inform as large an audience to its salientfeatures. Primarily through alliance and collaboration withWestern MDs, Tibetan medicine can express its principlesin a clear and beneficial way. This would develop throughdialogue, research, and ultimately the sharing of intellectualresources. This article is intended as a brief survey ofTibetan medicine’s ancient history, its development into thepresent, and an exploration into future collaborations. Uponreview it can be seen that Tibetan medicine is an excellentexample of personalized and preventive medicine.

History of Tibetan medicine

Aspects of Tibetan medicine can be found in ancient cultures asold as 2,500 years. It was in the Kingdom of Shang Shung thatpractitioners of the Bön Shamanistic religion recorded formaltexts describing healing rituals, medical divination, andastrology. Practices such as medical divination lead to muchthe same nature of treatment. A divination would be madeindicating a particular elemental disturbance and a ritual

P. Roberti di SarsinaExpert for Non-conventional medicine, High Council of Health,Ministry of Health,Rome, Italy

P. Roberti di SarsinaObservatory and Methods for Health,Universtity of Milano-Bicocca,Milano, Italy

P. Roberti di SarsinaCharity “Association for Person Centred Medicine”,Bologna, Italy

P. Roberti di Sarsina (*)Via Siepelunga 36/12,40141 Bologna, Italye-mail: [email protected]

L. OttavianiInternational Shang Shung Institute for Tibetan Studies,Arcidosso, Italy

J. MellaShang Shung Institute,Conway, USA

EPMA Journal (2011) 2:385–389DOI 10.1007/s13167-011-0130-x

REVIEW ARTICLE

Regional Health Systems and non-conventional medicine:the situation in Italy

Mara Tognetti Bordogna

Received: 18 April 2011 /Accepted: 14 June 2011 /Published online: 20 July 2011# European Association for Predictive, Preventive and Personalised Medicine 2011

Abstract In Italy the different regional healthcare modelsare structured, in order to provide both a single theoreticalframework and to enable direct comparisons. In this paperwe examine whether and how the regional healthcaresystems include alternative medicines and, if so, whetherthis can be specifically attributed to the different organisa-tional models in place. This analysis will be preceded by aframework to show how in Italy there is a constant andcontinuous increase in non-conventional medicine (NCM),determined from a research by citizens of a person-centredmedicine and preventive. We shall examine how NCM hasbeen incorporated in the National Health System (SSN) inItaly, from the time the Regional Health Systems were setup, and the factors that have contributed to their inclusionor exclusion. After a brief synopsis of the process ofgrowth, distribution and recognition of NCM in Italy, weshall describe how it has been incorporated and consolidat-ed in the regional healthcare systems.

Keywords Personalised medicine . Complementary andalternative medicine CAM . Preventive measures . Regionalhealth delivery . Dominant health system . Italy

Introduction

Complementary and alternative medicine (CAM) or non-conventional medicine (NCM), as this broad domain isdefined in Italy considering that they are neither part of the

dominant health system nor included in the mandatorycurriculum for graduation as a Doctor of Medicine (MD) inItaly, embraces a variety of healthcare cures which are moreand more consolidated worldwide, although varying fromcontinent to continent and country to country, as do thelevels of recognition and degree of regulatory legislationthroughout the world.

In Italy the debate on the effectiveness of cures andvalidity of the various NCMs is still ongoing. Despite this,some Servizi Sanitari Regionali (SSR)—Regional HealthSystems—use them to integrate biomedicine.

This “assimilation” ranges from services that recognise andsupport them as forms and methods of care on a part withbiomedicine, which is the dominant health system in Italy, tothose that do not recognise evidence of their curative value.

The debate does not seem to consider the fact that thepublic makes constant use of NCM to address their healthproblems and that more and more doctors practise andprescribe them.

In the literature in general [1], and in particular in thefield of sociology, there is a growing interest in what wereonce described as alternative medicines—as opposed toofficial medicine—then promoted to complementary, andnow defined as non-conventional. The definition of NCM isclearly adopted both by the European Parliament (“Reso-lution on the status of non-conventional medicine”, 1997)and by the Council of Europe (“A European approach tonon-conventional medicines”, 1999).

There are many reasons for the appeal of NCM: the needfor a personal rapport with the physician, the specialattention given to the individual nature of the patient, theconsideration of the individual as a whole—physical,psychological and social, the appreciation of an approachthat values a patient’s resources, involvement in the processof diagnosis and cure [2, 3].

M. T. Bordogna (*)Department of Sociology and Social Research,University of Milano-Bicocca,Via Bicocca degli Arcimboldi 8,20126 Milano, Italye-mail: [email protected]


REVIEW ARTICLE

Traditional and non-conventional medicines:the socio-anthropological and bioethical paradigmsfor person-centred medicine, the Italian context

Paolo Roberti di Sarsina & Ilaria Iseppato

Received: 2 May 2011 /Accepted: 19 July 2011 /Published online: 11 August 2011# European Association for Predictive, Preventive and Personalised Medicine 2011

Abstract In Italy the use of non-conventional medicines(NCM) is spreading among people as in the rest of Europe.However, in Italy, unlike that in other countries of theEuropean Union, at the present time the juridical/legal statusof NCM is not well established, mainly due to the lack of anynational law regulating NCM professional training, practiceand public supply and to the absence of government-promotedscientific research in this field. This is an obstacle tosafeguarding the patient’s interests and freedom of choice,especially now that dissatisfaction with biomedicine isinclining more and more people to look for a holistic, fairerand person-centered form of medicine.

Keywords Non-conventional medicine legal status .

Person-centered medicine .Mainstream medicine .

Complementary and alternative medicine . Health-genesis .

Pharmacoeconomy

Some points of terminology

The World Health Organization has long called non-conven-tional medicine “Traditional Medicine” in deference to thecountries where such forms of healing are in the long-standingcultural heritage: one thinks of China and India.

The term adopted by the Cochrane Collaboration and theinternational literature is actually “Complementary andAlternative Medicine” (Consensus Conference, UnitedStates Office for Alternative Medicine of the NationalInstitutes of Health, Bethesda, USA, 1997); one immedi-ately infers that this has a multiple sense, coveringtreatments chosen exclusively, i.e. as first-choice therapy(alternative medicine), or second-choice therapy, i.e. incombination with others (complementary medicine). Tradi-tional and non-conventional medicine is the commonestterm in Italian usage, which we shall be adopting forvarious reasons: it is less charged with ideology, hencemore neutral scientifically; it is a dynamic and relativedescription of medicines which should not be seen asinferior to conventional medicine. These are the forms thatare currently excluded from the official line-up of the healthservice and from teaching in the medical faculty. “Non-conventional” is here synonymous with “unorthodox”,“different” from biomedicine.

For these reasons we prefer to stick to “non-conventionalmedicine” (NCM) for the Italian setting. It is socially morewidespread, better known, understood in common Italianparlance, used by the FNOMCeO in its Terni Document(2002), by the European Parliament (1997) and the Councilof Europe (1999), used again in the Consensus Documenton NCM in Italy (2003). Besides, the term NCM ties upwith the fact that such disciplines are not properly includedas obligatory subjects on an Italian degree course inmedicine or veterinary science, unlike the practice of

P. Roberti di SarsinaExpert for Non Conventional Medicine, High Council of Health,Ministry of Health,Rome, Italy

P. Roberti di SarsinaObservatory and Methods for Health,Department of Sociology and Social Research,University of Milan-Bicocca,Milan, Italy

I. IseppatoUniversity of Bologna,Bologna, Italye-mail: [email protected]

Present Address:P. Roberti di Sarsina (*)Via Siepelunga, 36/12,40141 Bologna, Italye-mail: [email protected]

EPMA Journal (2011) 2:439–449DOI 10.1007/s13167-011-0104-z

REVIEW ARTICLE

Salutogenesis and Ayurveda: indications for publichealth management

Antonio Morandi & Carmen Tosto &

Paolo Roberti di Sarsina & Dacia Dalla Libera

Received: 31 August 2011 /Accepted: 2 November 2011 /Published online: 1 December 2011# European Association for Predictive, Preventive and Personalised Medicine 2011

Abstract Ayurveda, the ancient traditional medicine ofIndia, defines health as a state of complete physical,mental and spiritual well-being. The focus of Ayurveda ison a predictive, preventive and personalized medicine.This is obtained through a low-cost personalized counsel-ing about lifestyle measures (diet, activities, etc.), trying toinvolve the patient directly in the process of healing,increasing his self-awareness and good relationships withother people and nature. The approach of Ayurveda towardpositive health shares its features with that of salutogenesisas described by Antonovsky. Prevention strategies prag-matically suggested by Ayurveda - including factors suchas promotion of health education, individual awareness,

integration of spirituality and ethics in healthcare system-may be applied in public health management, in order toimprove perceived and objective life quality, promotehealthy aging, limit drugs use (avoiding expensive side-effects) and reduce chronic diseases social costs. Ayurvedahas a universal-coverage, being person-centered andconsequently intercultural.

Keywords Ayurveda . CAM . Salutogenesis . Predictivemedicine . Preventive medicine . Personalized medicine

Ayurveda and the concept of health as personalized,predictive medicine

Tradition – whatever its nature or origin – is the distillationof experience and therefore memory itself. It is the onlypath to finding man’s true nature, recovering what has beenforgotten and understanding the meaning of life itself. Asone of the world’s most ancient traditions, Ayurveda(translated rom sanskrit “knowledge of duration of life”),the traditional medicine of India and first of all anthropo-logical/traditional medical systems, emphasizes the neces-sity of a more person-centered, personalized approach inmedicine [1–4]. The process of healing has to be based onpeople’s whole bio-psycho-spiritual unity and equilibrium,including their relation to the environment and the way theyperceive or “narrate” their own complex individual exis-tence, both in sickness and health. In Ayurveda thedeterminants of health are biological, ecological, medical,psychological, sociocultural, spiritual and metaphysicalfactors, all interdependent and wired together by thecommon concept of relationship. The harmonization andintegration of these determinants in a complex systemallows the emergence of what is identified as health.

A. Morandi (*) : C. Tosto :D. Dalla LiberaAyurvedic Point,C.SO Sempione 63,20149 Milan, Italye-mail: [email protected]: www.ayurvedicpoint.it

A. Morandi : P. Roberti di Sarsina :D. Dalla LiberaSSIMA, Italian Scientific Society for Ayurvedic Medicine,C.SO Sempione 63,20149 Milan, Italy

D. Dalla LiberaIRCCS San Raffaele, Department of Neurology,Via Olgettina 48,20132 Milan, Italy

P. Roberti di SarsinaExpert for non-conventional medicine, High Council of Health,Ministry of Health,Rome, Italy

P. Roberti di SarsinaObservatory and Methods for Health, Department of Sociologyand Social Research, University of Milan-Bicocca,Milan, Italy


Reflection process on EU health policy

Commissioner David Byrne 2004

Health & Consumer Protection Directorate-General

“Finally, a number of respondents have taken the opportunity of the reflection process to reiterate the importance of certain complementary health interventions such as nature healing, homeopathic medicine, alternative and complementary medicines, anthroposophic medicine and nutritional approaches. They would like to see national health systems and reimbursement arrangements recognise the value of these approaches” (page 5)

COMMISSIONER BYRNE’S REFLECTION PROCESS “ENABLING GOOD HEALTH FOR ALL” PREPARING THE GROUND FOR THE FUTURE HEALTH STRATEGY REPORT ON RESPONSES RECEIVED


EU Open Health Forum for Stakeholders “Health Challenges and Future Strategy”

Charlemagne Building of the European Commission Bruxelles 07-08.11.05

MANIFESTO ON COMPLEMENTARY AND ALTERNATIVE MEDICINE SIGNED AT

THE EUROPEAN OPEN FORUM CONFERENCE FOR STAKEHOLDERS, Bruxelles, 08.11.2005 This morning we have been talking about subjects such as putting patients concerns higher on the agenda and protecting them from health threats. If we realise that: • there is a growing demand among the European citizens for Complementary and Alternative Medicine (CAM) • clinical effectiveness of CAM is, in many cases, at least as high as the effectiveness of conventional medicine, as showed by several long-term studies involving many thousands of patients • CAM is not only effective but also very safe, and that, therefore, CAM can help to reduce the enormous burden of mortality and morbidity caused by the adverse effects of conventional prescription drugs it is high time that the European Union includes CAM in its policy. This document was signed by: Dr Ton Nicolai – European Committee for Homeopathy Dr Giancarlo Buccheri – International Federation of Anthroposophical Medical Associations Dr Wolfgang Schmitz-Harbauer – European Council of Doctors for Plurality in Medicine Dr Norbert Missel – Zentralverband der Ärzte für Naturheilverfahren und Regulationsmedizin Dr Walburg Masic-Oehler – Deutsche Ärztegesellschaft für Akupunktur Dr Madeleen Winkler – International Federation of Anthroposophical Medical Associations Mr Michel Pradelle – European Federation of Patients Associations for Anthroposophical Medicine Dr Paolo Roberti di Sarsina – Comitato Permanente di Consenso e Coordinamento per le Medicine Non Convenzionali In Italia Mr Colette Pradelle – European Federation of Patients Associations for Anthroposophical Medicine Mrs Alexsandra Hodgson – European Forum for Complemenatry and Alternative Medicine Mr Rainhard Schübel – Association of Natural Medicine in Europe Dr François Beyens – International Council for Medical Acupuncture and Related Techniques Mr Stephen Gordon – European Council for Classical Homeopathy Mr Seamus Connolly – European Shiatsu Federation

DECISIONI ADOTTATE CONGIUNTAMENTE DAL PARLAMENTO EUROPEO E DAL CONSIGLIO DECISIONE n.1350/2007/CE DEL PARLAMENTO EUROPEO E DEL CONSIGLIO del 23 ottobre 2007 che istituisce un secondo programma d’azione comunitaria in materia di salute (2008-2013) Il programma dovrebbe prendere atto dell’importanza di un’impostazione olistica della sanità pubblica e tenere in considerazione nelle sue azioni, ove appropriato e in presenza di prove scientifiche o cliniche di efficacia, la medicina complementare e alternativa. The Programme should recognise the importance of a holistic approach to public health and take into account, where appropriate and where there is scientific or clinical evidence about its efficacy, complementary and alternative medicine in its actions. 20.11.2007 Gazzetta Ufficiale dell’Unione Europea L 301/5


EU Open Health Forum 2008 “Developing and Implementing Health

in the European Union”

Charlemagne Building of the European Commission Bruxelles 10-11.12.08

In Brussels on 11th December 2008 at the European Open Health Forum 2008, organised by the European Commission – DG Health and Consumer Protection, the following manifesto on CAM was signed and presented to the European Commission, identifying them as a top priority for EU Health Policy: “Complementary and Alternative Medicine (CAM) is in strong demand among European citizens reflecting a need for more holistic patient-centred care. •  About 70% of the European population report that they have used CAM therapies. •  Clinical effectiveness of CAM is, in many cases, at least as high as the effectiveness of conventional medicine as shown by several long-term studies involving many thousands of patients. •  CAM has a positive safety profile and is effective, especially in individualised medicine. •  CAM manufacturing techniques help protect the environment. •  Integration of CAM in general health care can help reduce costs and the burden of mortality and morbidity caused by multiple adverse effects of many conventional prescription medicines. •  CAM is needed in fostering good health in Europe for the young and the old. •  CAM is a strong contribution to health promotion. For the benefit of all Europeans we strongly recommend that the European Union promote the integration of valid CAM and effective Medicinal Traditions in its health policy!”

(CAM)

European CAM research funding

http://www.cambrella.eu

CAMbrella A pan-European research network for

Complementary and Alternative Medicine

CAMbrella – history 20

04

2005

20

06

2007

20

08

2009

20

10

2011

20

12

Lobbying to bring CAM into FP7

Paving the way

First ad-hoc meetings Nov06/Jan07 Deadline proposal Dec08 Result of review process Apr09 Grant Agreement Oct09

Preparation

From Kick-off to final conference

Execution

FP7-Health-2009-single-stage

3. Optimising the delivery of healthcare to European citizens 3.1 Translating Clinical Research into practice 3.1-3 Complementary and alternative medicine

funding scheme: Coordination action, max 1,5 Mio €, max 1 project In order to create the knowledge base concerning the demands for Complementary and Alternative Medicine (CAM) and the prevalence of its use in Europe, consensus on the terminology of CAM and the definition of respective CAM methods needs to be established. The current state with respect to the provider’s perspective as well as needs and demands of the citizens should be explored; the different legal status of CAM in EU Member States needs to be taken into account. A roadmap for future European research in this area should be developed.

CAMbrella

CAMbrella – A pan-European research network for Complementary and Alternative Medicine (CAM) Start of the project: 1 Jan 2010 Duration: 3 years Consortium: 16 participants from 12 European countries

Coordinator: Wolfgang Weidenhammer, Klinikum rechts der Isar, Munich, Centre for Complementary Medicine Research

CAMbrella Kick-‐off MeeMng. Siemens FoundaMon, Munich, January 21-‐22, 2010.

George Lewith Helle Johannessen Vinjar Fønnebø Torkel Falkenberg Wolfgang Weidenhammer Bernhard Uehleke Benno Brinkhaus Klaus von Ammon Bettina Reiter

131 ECHAMP Symposium Brussels, Nov 18, 2009

The CAMbrella consortium

132

CAMbrella Advisory Board

Organization Abbrev. Web-site

European Public Health Association EPHA www.epha.org

European Central Council of Homeopaths ECCH www.homeopathy-ecch.org

European Forum for Complementary and Alternative Medicine EFCAM www.efcam.eu

European Coalition on Homeopathic and Anthroposophic Medicinal Products ECHAMP www.echamp.org

Association of Natural Medicine in Europe ANME www.anme.info

European Information Centre for Complementary and Alternative Medicine EICCAM www.eiccam.eu

International Council of Medical Acupuncture and Related techniques ICMART www.icmart.org

European Committee for Homeopathy ECH www.homeopathyeurope.org

European Herbal & Traditional Medicine Practitioners’ Association EHTPA www.ehpa.eu

International Federation of Anthroposophic Medical Associations IVAA www.ivaa.eu

Kneipp-Bund eV KB www.kneippbund.de

European Council of Doctors for Plurality in Medicine ECPM www.ecpm.org

CAMbrella Scientific Steering Board Coordinator of CAMbrella Wolfgang Weidenhammer, Klinikum Rechts der Isar, Germany

Coordinator Bernhard Uehleke, University of Zurich, Switzerland WP1 Terminology and definiKon of CAM methods

Coordinator Vinjar Fønnebø, Universitetet I Tromsoe, Norway WP2 Legal status and regulaKons

Coordinator Helle Johannessen, Syddansk Universitet, Denmark WP3 Needs and aYtudes of ciKzens

Coordinator George Lewith, University of Southampton, UK WP4 CAM use – the paKents’ perspecKve

Coordinator Klaus von Ammon, University of Berne, Switzerland WP5 CAM use – the providers’ perspecKve

Coordinator Torkel Falkenberg, Karolinska InsKtutet, Sweden WP6 The global perspecKve

Coordinator Benno Brinkhaus, Charité University, Germany WP7 Roadmap for future CAM research

Coordinator Be?na Reiter, Gamed, Austria WP8 DisseminaKon and communicaKon

Coordinator Franziska Baumhöfener, BayFOR, Germany WP9 Management

CAMbrella

Objectives To develop a proposal for consensus on a series of definitions for the terminology used to describe the major CAM interventions used clinically in Europe. To create a knowledge base that allows us to accurately evaluate the patient demands for CAM and its prevalence of use in Europe. To review current legal status of CAM in Europe. To explore the needs, beliefs and attitudes of the EU citizens with respect to CAM.

continued

CAMbrella

Objectives To explore the providers’ perspectives on CAM treatment in Europe. To propose an appropriate research strategy that will develop our understanding of CAM use and its effectiveness within an EU context in response to the needs of healthcare funders, providers and patients. This will take account of the issues of effectiveness, cost, safety and the legal requirements for the production of medicinal substances. To develop a process for prioritizing future EU research strategy the current policies within the EU have to be considered. To facilitate and foster a sustainable, high quality collaboration of European CAM researchers by actively supporting a regional interest group within an international society for CAM research.

3. OpMmising the delivery of healthcare to European ciMzens 3.1 TranslaKng Clinical Research into pracKce 3.1-‐3 Complementary and alternaKve medicine

In order to create the knowledge base concerning the demands for Complementary and AlternaKve Medicine (CAM) and the prevalence of its use in Europe, consensus on the terminology of CAM and the definiKon of respecKve CAM methods needs to be established. The current state with respect to the provider’s perspecKve as well as needs and demands of the ciKzens should be explored; the different legal status of CAM in EU Member States needs to be taken into account. A roadmap for future European research in this area should be developed. Completed by the Global PerspecKve.

CAM topic – the task

WP1 WP2 WP3 WP4 WP5 WP6 WP7

CAMbrella A pan-‐European research network for Complementary and AlternaMve Medicine (CAM)

137

Structure of the Work Packages

Work Packages

WP1: CAM terminology and definitions

WP2: Legal status and regulations

WP3: Needs and attitudes of citizens

WP6: CAM research – the global perspective

WP4: CAM use –patients‘ perspective

WP5: CAM use – providers‘ perspective

WP7: Review of CAM research methodology + Roadmap for

European CAM research

WP8: Dissemination and communication

138

CAMbrella – in a nutshell

Title CAMbrella – A pan-European research network for Complementary and Alternative Medicine (CAM)

Start of the project Jan 1, 2010 Duration 3 years Consortium 16 participants from 12 European countries plus one

adjunct partner from Netherlands Coordinator Klinikum rechts der Isar, Techn. Univ., Munich

Competence Centre for Complementary Medicine and Naturopathy (Head: D Melchart); contact: W Weidenhammer

Funding max 1.5 m. € (FP7/2007-2013, GA No. 241951) Funding scheme: Coordination action

Aims to review the status quo of CAM in the EU and to provide a proposal (=roadmap) for CAM research

Impact Research roadmap and network to enable sustainable and prioritised CAM research in the EU

Information www.cambrella.eu

CAMbrella Midterm MeeMng, Bologna 23-‐25 March 2011, Cà La Ghironda FoundaMon

CAMbrella Final Conference, Bruxelles 29 November 2012.

141

23/11/09 21.59European Commission: CORDIS: FP7 : Find project

Pagina 2 di 3http://cordis.europa.eu/fetch?CALLER=FP7_PROJ_EN&ACTION=D&DOC=1&CAT=PROJ&QUERY=0124de4572a5:c2b4:4a799312&RCN=92501

generated will be disseminated through our website, peer review publications and a final conference,with emphasis on current and future EU policies, addressing the different target audiences with aninterest in CAM.

Project detailsProject Acronym: CAMBRELLA Project Reference: 241951 Start Date: 2010-01-01 Duration: 36 months Project Cost: 1.67 million euro Contract Type: Coordination (or networking) actions End Date: 2012-12-31 Project Status: Accepted Project Funding: 1.5 million euro

ParticipantsCOMITATO PERMANENTE DI CONSENSO E COORDINAMENTO PER LEMEDICINE NON CONVENZIONALI IN ITALIA ITALY

UNIVERSITETET I TROMSOE NORWAYWIENER INTERNATIONALE AKADEMIE FÜR GANZHEITSMEDIZIN AUSTRIABAYERISCHE FORSCHUNGSALLIANZ GEMEINNUTZIGE GMBH GERMANYUNIVERSITATEA DE MEDICINA SI FARMACE VICTOR BABESTIMISOARA ROMANIA

AGENZIA SANITARIA E SOCIALE REGIONALE - REGIONE EMILIA-ROMAGNA ITALY

SERVICIO ANDALUZ DE SALUD SPAINUNIVERSITE PARIS 13 FRANCESYDDANSK UNIVERSITET DENMARK

UNIVERSITY OF SOUTHAMPTON UNITEDKINGDOM

PECSI TUDOMANYEGYETEM - UNIVERSITY OF PECS HUNGARYUNIVERSITAET BERN SWITZERLANDUNIVERSITAET ZUERICH SWITZERLANDKAROLINSKA INSTITUTET SWEDENCHARITE - UNIVERSITAETSMEDIZIN BERLIN GERMANY

Record Control Number: 92501Update Date: 2009-10-30 13:18:51.0

23/11/09 21.59European Commission: CORDIS: FP7 : Find project

Pagina 1 di 3http://cordis.europa.eu/fetch?CALLER=FP7_PROJ_EN&ACTION=D&DOC=1&CAT=PROJ&QUERY=0124de4572a5:c2b4:4a799312&RCN=92501

Community Research and Development Information Service - CORDIS

European Commission > CORDIS > FP7 > Find project

Seventh Framework Programme (FP7)

FIND A PROJECT

Cambrella: a pan-European research network for complementary and alternative medicine (CAM) (CAMBRELLA)

Funded under 7th FWP (Seventh Framework Programme)

Research area: HEALTH-2009-3.1-3 Complementary and Alternative Medicine

CoordinatorContact Person: Name: WEIDENHAMMER, Wolfgang (Dr) Tel: +49-89-72669720 Fax: +49-89-72669721 Email: ContactOrganisation: KLINIKUM RECHTS DER ISARISMANINGER STR.GERMANY

Project description

The goal of this collaboration is to develop a roadmap for future European research in CAM that isappropriate for the health care needs of EU citizens, and acceptable to the EU parliament as well astheir national research funders and healthcare providers. We will enable meaningful reliablecomparative research and communication within Europe and create a sustainable structure and policy.CAMbrella is focussed on academic research groups which do not advocate specific treatments. TheAdvisory Board represents the main CAM stakeholders including consumers, practitioners, clinicalproviders, and manufacturers of CAM medicinal products. The specific objectives are to develop anEU network involving centres of research excellence for collaborative research, to develop consensus-based terminology widely accepted in Europe to describe CAM interventions, to create a knowledgebase that facilities our understanding of patient demand for CAM and its prevalence, to review thecurrent legal status and policies governing CAM provision in the EU and, to explore the needs, beliefsand attitudes of the EU citizens with respect to CAM. Based on this information we will create aroadmap that will enable a sustainable and prioritised EU research roadmap for CAM. We willachieve this in 3 years by creating dialogue between researchers from 12 EU member and associatedstates. We will set up a mechanism that will allow fruitful and thoughtful discussion throughout theEU. To facilitate this coordinating action the project will be delivered in 9 independent but interrelatedwork packages whose members meet regularly. It will be coordinated by a Management Board anddirected by a Scientific Steering Committee with support of an Advisory Board. The outcomes

CAMbrella’s results of three years work

European ConsorMum CAMbrella (FP7) CAMbrella Work Package 2 -‐ Legal status and regulaMon of CAM in Europe -‐ Final Report (314 pages)

Foreword

This report is developed by WP2 in the CAMbrella consorKum in the period January 1, 2010 to April 30, 2012, and has been updated in the period from May to October 2012. The present report represents the updated version from November 5, 2012. The aim of this work package was to review and describe in all 27 EU member states as well as 10 associated states (later expanded with two addiKonal countries):

• The legal status of CAM • The regulatory status of CAM pracMces

• The governmental supervision of CAM pracMces • The reimbursement status of CAM pracMces and medicinal products

• The regulaMon of CAM medicinal products

An addiKonal aim was to review at the EU level: • The status of EU-‐wide regulaMon of CAM pracMces and medicinal products

• The potenMal obstacles for EU-‐wide regulaMon of CAM pracMces and medicinal products

The country-‐specific status has been described on the basis of publicly available legal and regulatory documents supplemented by personal visits to a purposive sample of countries. The status with regard to regulaKon of CAM medicinal products and the EU-‐wide regulaKon of CAM has been described on the basis of publicly available legal and regulatory documents only.

The work of WP2 Legal status and regulaMon of CAM in Europe is presented in three separate reports: 1. Part I -‐ CAM regulaMons in the European countries (1-‐243)

2. Part II -‐ Herbal and homeopathic medicinal products (244-‐273) 3. Part III -‐ CAM regulaMons in EU/EFTA/EEA (274-‐314)

17/04/13 13:55CAMbrella: la relazione finale su status giuridico e regolamentazione delle MNC in Europa

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CAMbrella: la relazione finale su status giuridico eCAMbrella: la relazione finale su status giuridico eregolamentazione delle MNC in Europaregolamentazione delle MNC in Europa

Riceviamo e volentieri pubblichiamo (vedi allegato) la relazione finale del GruppoGruppo

di Lav oro 2di Lav oro 2 del Consorzio CAMbrella (finanziato sotto il Settimo ProgrammaQuadro per la Ricerca e lo Sviluppo - FP7) concernente "Lo Status Giuridico e la

Regolamentazione delle Medicine Non Convenzionali in Europa".

Il Consorzio CAMbrella, rappresentato in Italia dal dottor Paolo Roberti diSarsina, è la prima rete di eccellenza sulle Medicine Non Convenzionali costituitasotto l'egida di un programma pluriennale di finanziamento per la ricerca nellastoria dell'Unione Europea.

a cura di Redazione FNOMCeO Web

Articolo pubblicato in: News

Documenti allegati:

CAMbrella Work Package 2 - Legal status and regulation of CAM in Europe - Final Report

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European ConsorMum CAMbrella (FP7) CAMbrella Work Package 2 -‐ Legal status and regulaMon of CAM in Europe -‐ Final Report (314 pages)

A pan-European research network for Complementary and Alternative Medicine (CAM)

Final report of CAMbrella Work Package 2 (leader: Vinjar Fønnebø)

Legal status and regulation of CAM in Europe

Part I - CAM regulations in the European countries Solveig Wiesener, Torkel Falkenberg, Gabriella Hegyi, Johanna Hök, Paolo Roberti di Sarsina, Vinjar Fønnebø This report is part of a collection of reports created as deliverables of the project CAMbrella funded by the 7th Framework Programme of the European Commission (FP7-HEALTH-2009-3.1-3, Coordination and support action, Grant-Agreement No. 241951, Jan 1, 2010 – Dec 31, 2012); Coordinator: Wolfgang Weidenhammer, Competence Centre for Complementary Medicine and Naturopathy (head: Dieter Melchart), Klinikum rechts der Isar, Techn. Univ. Munich, Germany

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Part II - Herbal and homeopathic medicinal products Vinjar Fønnebø, Torkel Falkenberg, Gabriella Hegyi, Johanna Hök, Paolo Roberti di Sarsina, Solveig Wiesener This report is part of a collection of reports created as deliverables of the project CAMbrella funded by the 7th Framework Programme of the European Commission (FP7-HEALTH-2009-3.1-3, Coordination and support action, Grant-Agreement No. 241951, Jan 1, 2010 – Dec 31, 2012); Coordinator: Wolfgang Weidenhammer, Competence Centre for Complementary Medicine and Naturopathy (head: Dieter Melchart), Klinikum rechts der Isar, Techn. Univ. Munich, Germany

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Part III - CAM regulations in EU/EFTA/EEA Solveig Wiesener, Torkel Falkenberg, Gabriella Hegyi, Johanna Hök, Paolo Roberti di Sarsina, Vinjar Fønnebø This report is part of a collection of reports created as deliverables of the project CAMbrella funded by the 7th Framework Programme of the European Commission (FP7-HEALTH-2009-3.1-3, Coordination and support action, Grant-Agreement No. 241951, Jan 1, 2010 – Dec 31, 2012); Coordinator: Wolfgang Weidenhammer, Competence Centre for Complementary Medicine and Naturopathy (head: Dieter Melchart), Klinikum rechts der Isar, Techn. Univ. Munich, Germany

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References for Italy (WP2 Final Report, Part 1, 229-‐230)

168. RoberK di Sarsina P, Iseppato I, editors. Non ConvenMonal Medicine within the Italian Medical Profession. ECIM

2011; 2011; Berlin.

169. RoberK di Sarsina P, Iseppato I. TradiMonal and Non ConvenMonal Medicines: the Socioanthropological and

Bioethical Paradigm for Person-‐Centred medicine. The Italian context. EPMA. 2011;2:439-‐49.

170. RoberK di Sarsina P, Iseppato I. State of Art of the RegulaMve SituaMon of Non ConvenMonal Medicines in Italy. The

Journal of AlternaKve and Complementary Medicine 2010;16(2):141-‐2.

171. RoberK di Sarsina P, Iseppato I. Looking for a Person-‐Centered Medicine: Non ConvenMonal Medicine in the

ConvenMonal European and Italian Se?ng. Evidence-‐Based Complementary and AlternaKve Medicine 2011;2011.

172. RoberK di Sarsina P, Iseppato I. Non-‐ConvenMonal Medicine in Italy: The present situaMon. European Journal of

IntegraKve Medicine. 2009;1(2):65-‐71.

175. FraDari L, Khanchandani B, P. RoberK di Sarsina, Williams J. The EvoluMon of ChiropracMc RegulaMon in Italy.

AssociaKon of Italian Chiropractors submission to CAMbrella, 31 December 2011.

Original Article

Forsch Komplementmed 2012;19(suppl 2):29–36 Published online: November, 2012

DOI: 10.1159/000343125

Solveig WiesenerNational Research Center in Complementary and Alternative Medicine (NAFKAM)Department of Community Medicine, University of Tromsø9037 Tromsø, [email protected]

© 2012 S. Karger GmbH, Freiburg1661-4119/12/0198-0029$38.00/0



Legal Status and Regulation of Complementary and Alternative Medicine in EuropeSolveig Wiesenera Torkel Falkenbergb,c Gabriella Hegyid Johanna Hökb,c Paolo Roberti di Sarsinae Vinjar Fønnebøa

a National Research Center in Complementary and Alternative Medicine (NAFKAM), Department of Community Medicine, University of Tromsø, Norway

b Research Group Integrative Care, Divison of Nursing, Department of Neurobiology, Caring Sciences and Society, Karolinska Institutet, Huddinge,

c IC – The Integrative Care Science Center, Swedend Health Science Faculty, Pécs University, Hungarye Expert for Non-Conventional Medicine, High Council of Health, Ministry of Health, Bologna, Italy

KeywordsAlternative medicine · Complementary medicine · Regulation · Government regulation · Legislation · European Union · Europe

SummaryObjective: The study aims to review the legal and regula-tory status of complementary and alternative medicine (CAM) in the 27 European Union (EU) member states and 12 associated states, and at the EU/European Eco-nomic Association (EEA) level. Methods: Contact was es-tablished with national Ministries of Health, Law or Edu-cation, members of national and European CAM associa-tions, and CAMbrella partners. A literature search was performed in governmental and scientific/non-scientific websites as well as the EUROPA and EUR-lex websites/databases to identify documents describing national CAM regulation and official EU law documents. Results: The 39 nations have all structured legislation and regula-tion differently: 17 have a general CAM legislation, 11 of these have a specific CAM law, and 6 have sections on CAM included in their general healthcare laws. Some countries only regulate specific CAM treatments. CAM medicinal products are subject to the same market au-thorization procedures as other medicinal products with the possible exception of documentation of efficacy. The directives, regulations and resolutions in the EU that may influence the professional practice of CAM will also affect the conditions under which patients are receiving CAM treatment(s) in Europe. Conclusion: There is an extraordinary diversity with regard to the regulation of

CAM practice, but not CAM medicinal products. This will influence patients, practitioners and researchers when crossing European borders. Voluntary harmonization is possible within current legislation. Individual states within culturally similar regions should harmonize their CAM legislation and regulation. This can probably safe-guard against inadequately justified over- or underregu-lation at the national level.

Introduction

The European Parliament [1] and the Parliamentary Assem-bly of the Council of Europe [2] have both passed resolutions recommending a stronger harmonization of, what they call, non-conventional medicine in Europe.

The European Union (EU) has, however, repeatedly con-firmed that it is up to each member state to organize and regulate their healthcare system, and this will, of course, also apply to complementary and alternative medicine (CAM). Despite this confirmation, the recent Patients’ Rights in Cross-Border Healthcare Directive 2011/24/EU [3] and other directives indirectly encourage some degree of harmoniza-tion. CAM professions can be registered in the European Commission (EC) database of regulated professions, and patients will probably have certain rights according to the Cross-Border Healthcare Directive. The EU has also passed directives regulating medicinal products that also cover CAM medicinal products [4–6].

Israel

FRANCE

ANDORRA

GERMANY POLAND

ROMANIA BULGARIA

GREECE TURKEY BALEARIC

SWITZ. AUSTRIA

UKRAINE

Crete ALGERIA

ALB.

TUNISIA

ISLANDS

BELGIUM LUX.

SERBIA LIECH

Sicily

© Bruce Jones Design Inc. 2006 • www.bjdesign.com • www.clipartmaps.com

0 0 300 Miles 300 Kilometers

RUSSIA

RUSSIA

FINLAND SWEDEN

NETHERLANDS

DENMARK

ICELAND

BELARUS UNITED KINGDOM

White Sea

SPAIN

MOROCCO

NORWAY

MOLDOVA

F.Y.R.O.M.

IRELAND

PORTUGAL

MALTA

ITALY MONACO

BOSNIA AND HERZEGOVINA SLOVENIA HUNGARY

SLOVAKIA CZECH REPUBLIC

NORTHERN IRELAND LITHUANIA

LATVIA ESTONIA

Corsica FRANCE Sardinia I TALY

CROATIA MONTENEGRO KOSOVO

Gibralta

EU 1993

EU 1995

EU 2004

EU 2007

EFTA/EEA

EFTA FP7/candidate

Cypros

European Union

Israel

FRANCE

ANDORRA

GERMANY POLAND

ROMANIA BULGARIA


SWITZ. AUSTRIA

UKRAINE

Crete ALGERIA

ALB.

TUNISIA

ISLANDS

BELGIUM LUX.

SERBIA LIECH

Sicily



RUSSIA

RUSSIA

FINLAND SWEDEN

NETHERLANDS

DENMARK

ICELAND


White Sea

SPAIN

MOROCCO

NORWAY

MOLDOVA

F.Y.R.O.M.

IRELAND

PORTUGAL

MALTA

ITALY MONACO




LATVIA ESTONIA



Gibralta Cypros

European countries with CAM legislation

9

20

4

CAM law

Treatment law

No law

Info to be checked

5

FRANCE

ANDORRA

GERMANY POLAND

ROMANIA BULGARIA


SWITZ. AUSTRIA

UKRAINE

Crete ALGERIA

ALB.

TUNISIA

ISLANDS

BELGIUM LUX.

SERBIA LIECH

Sicily



RUSSIA

RUSSIA

FINLAND SWEDEN

NETHERLANDS

DENMARK

ICELAND


White Sea

SPAIN

MOROCCO

NORWAY

MOLDOVA

F.Y.R.O.M.

IRELAND

PORTUGAL

MALTA

ITALY MONACO




LATVIA ESTONIA



Gibralta

Comparing ��6 European countries CAM law

Treatment law

No law

Croatia EU Candidate

The Czech Republic EU 2004

Denmark EU 1993

Hungary EU 2004

Norway EFTA/EEA

Portugal EU 1993

CAMbrella - Work Package 2 Report Part I Page 13

Figure 3.1.1 Country relationship to the European Union map

3.2 How EU legislation influences national CAM legislation

The EU Treaties have repeatedly established that health policy is a national responsibility for the member states. This is adjusted and confirmed in the Lisbon Treaty in TITLE XIV Public Health Article 168 number 7(4): “7. Union action shall respect the responsibilities of the Member States for the definition of their health policy and for the organisation and delivery of health services and medical care. The responsibilities of the Member States shall include the management of health services and medical care and the allocation of the resources assigned to them. The measures referred to in paragraph 4(a) shall not affect national provisions on the donation or medical use of organs and blood”.

This statement is important to keep in mind when describing national legislation and regulation of CAM. Despite the statement, the following EU Directives and Regulations can potentially influence national legislation regarding CAM practices, treatments and patients’ rights and safety:


Figure 5.1.1 General CAM legislation map

Table 5.1.1 General CAM legislation - countries

General CAM legislationCAM law (11) General CAM legislation in health laws (6)

Belgium Original EU memberDenmark Original EU memberGermany Original EU memberPortugal Original EU memberIceland EFTA Switzerland EFTALiechtenstein EFTA Norway EFTA Hungary 2004 EU member Malta 2004 EU member Slovenia 2004 EU member Bulgaria 2007 EU member Romania 2007 EU member Macedonia Candidate EU Serbia Candidate EU Albania Potential candidate EU Bosnia &

Herzegovina Potential candidate EU


5.2 Acupuncture

Figure 5.2.1 Acupuncture map

Table 5.2.1 Acupuncture regulations - countries

Regulated profession and EU registered (2)

Regulated professionNot EU registered (0)

Regulated treatment Not regulated profession (24)

No regulation (13)

Malta Austria Lithuania Albania Switzerland Belgium Luxembourg Bosnia/Herzegovina Bulgaria Macedonia Croatia Cyprus Portugal Estonia Czech Republic Romania Finland Denmark Serbia Iceland France Slovakia Ireland Germany Slovenia Israel Greece Spain Montenegro Hungary Turkey Norway Italy UK Poland Latvia Sweden Liechtenstein The Netherlands


5.3 Anthroposophic medicine

Figure 5.3.1 Antroposophic medicine map

Table 5.3.1 Anthroposophic medicine regulations - countries



Regulated treatmentNot regulated profession (7)

No regulation (32)

Austria Bulgaria Germany Hungary Latvia Sweden Switzerland

7 countries have specific regulations on anthroposophic medicine. In Bulgaria and Latvia anthroposophic medicine is statutory registered as an additional education for medical doctors. In Austria diplomas awarded by the Austrian Medical Board specialise physicians in anthroposophic medicine. In Germany anthroposophic medicine is regulated by law as “a


5.4 Ayurveda

Figure 5.4.1 Ayurveda map

Table 5.4.1 Ayurveda regulations - countries




No regulation (34)

Hungary Latvia Romania Serbia Slovenia

We have found that ayurvedic medicine is directly mentioned in regulations in 5 out of 39 countries. In some of the other 34 countries ayurvedic medicine is recognized as a therapeutic system that may be provided by regulated health personnel (often doctors), but not directly mentioned in the regulations.


5.5 Chiropractic

Figure 5.5.1 Chiropractic map

Table 5.5.1 Chiropractic regulations - countries




No regulation (13)

Cyprus Belgium Albania Bosnia & HerzegovinaDenmark Bulgaria Austria Croatia Finland Germany Czech Republic Greece Iceland Hungary Estonia Ireland Liechtenstein Israel France Latvia Malta Italy Portugal Lithuania Norway Romania Luxembourg Sweden Serbia Macedonia Switzerland Slovakia Montenegro UK Slovenia Poland Spain The Netherlands Turkey


5.6 Herbal medicine/Phytotherapy

Figure 5.6.1 Herbal medicine/Phytotherapy map

Table 5.6.1 Herbal medicine / Phytotherapy regulations - countries




No regulation (29)

Albania Bulgaria Germany Hungary Portugal Romania Serbia Spain Switzerland UK


5.7 Homeopathy

Figure 5.7.1 Homeopathy map

Table 5.7.1 Homeopathy regulations - countries




No regulation (15)

Switzerland Latvia Albania Hungary Bosnia & Herzegovina Liechtenstein Austria Lithuania Cyprus Belgium Italy Finland Bulgaria Poland Iceland Croatia Portugal Ireland Czech Republik Romania Israel Denmark Serbia Luxembourg Estonia Slovenia Macedonia France Spain Malta Germany UK Montenegro Greece Norway Sweden Slovakia The Netherlands Turkey


5.8 Massage

Figure 5.8.1 Massage map

Table 5.8.1 Massage regulations - countries


Regulated profession Not EU registered (3)

Regulated treatmentNot regulated profession(1)

No regulation (19)

Austria Italy Estonia Turkey Albania MacedoniaBelgium Liechtenstein Portugal Bosnia &

Herzegovina Malta

Bulgaria Lithuania Romania Croatia MontenegroCzech Republik Luxembourg Cyprus Norway Finland Poland Denmark Serbia Germany Slovakia France Spania Hungary Slovenia Greece Sweden Iceland Switzerland Ireland The Netherlands Israel UK Latvia


5.9 Naprapathy

Figure 5.9.1 Naprapathy map

Table 5.9.1 Naprapathy regulations - countries



Regulated treatmentNot regulated profession(0)

No regulation (37)

Finland Sweden

Naprapathy is a regulated and protected profession in Finland and Sweden. Finland has registered their naprapath profession in the EU regulated professions database as physical therapist with the title “Naprapaati/Naprapat”. Sweden has registered their naprapath profession in the EU database as chiropractor with the title “naprapat”.

We have not found that naprapathy is recognized or practised in the other 37 countries. In some countries “manual therapy” or “physical therapy” is a common terminology for similar treatments.


5.10 Naturopathy

Figure 5.10.1 Naturopathy map

Table 5.10.1 Naturopathy regulations - countries




No regulation (31)

Switzerland Liechtenstein Albania Cyprus France Germany Portugal Romania

Naturopathy is a regulated profession in 2 countries (Switzerland, Liechtenstein). Switzerland has regulated the profession “natural health practitioner” and has registered two different professions in the EU regulated professions database, naturopathe/ homéopathe(FR) and naturopathe (de tradition Européenne)(FR). Liechtenstein has not


5.11 Neural therapy

Figure 5.11.1 Neural therapy map

Table 5.11.1 Neural therapy regulations - countries




No regulation (36)

Austria Hungary Switzerland

3 countries (Austria, Hungary, Switzerland) have specific regulation on neural therapy. In Austria diplomas awarded by the medical association specialise physicians in neural therapy. In Hungary CAM legislation regulates neural therapy. In Switzerland neural therapy is included in federal laws.

36 countries have no specific regulation on neural therapy. General CAM and health regulations may influence neural therapy practices.


5.12 Osteopathy

Figure 5.12.1 Osteopathy map

Table 5.12.1 Osteopathy regulations - countries




No regulation (24)

Finland France BelgiumIceland Hungary BulgariaLiechtenstein Latvia ItalyMalta PortugalSwitzerland RomaniaUK Slovenia

In 9 countries osteopath is a regulated profession. 6 countries have registered the profession in the EU regulated professions database. (Finland, Iceland, Liechtenstein, Malta, Switzerland, UK). Finland, Iceland, Liechtenstein, Malta require a qualification level PS3 – diploma of post-secondary level (3-4 years). In Switzerland the qualification level is 5 years


5.13 Traditional Chinese Medicine (TCM)

Figure 5.13.1 TCM map

Table 5.13.1 TCM regulations - countries




No regulation (29)

Austria Bulgaria Estonia Hungary Liechtenstein Romania Serbia Slovenia Switzerland UK

Original Article

Forsch Komplementmed 2012;19(suppl 2):37–43 Published online: November, 2012

DOI: 10.1159/000343129

Klaus von Ammon, MDInstitute of Complementary Medicine KIKOMUniversity of Bern, Imhoof-Pavillon, Inselspital3010 Bern, [email protected]

© 2012 S. Karger GmbH, Freiburg1661-4119/12/0198-0037$38.00/0



Complementary and Alternative Medicine Provision in Europe – First Results Approaching Reality in an Unclear Field of PracticesKlaus von Ammona Martin Frei-Erba Francesco Cardinib Ute Daiga Simona Draganc Gabriella Hegyid Paolo Roberti di Sarsinae,f Jan Sörenseng George Lewithh

a Institute of Complementary Medicine KIKOM, University of Bern, Switzerlandb Health and Social Regional Agency (ASSR) Emilia Romagna, Bologna, Italyc University of Medicine and Pharmacy Victor Babes, Timisoara, Romaniad PTE Pecs University Medical School, CAM Department, Pecs, Hungarye High Council of Health, Ministry of Health, Rome,f Committee for CAM in Italy, Bologna, Italyg Centre for Applied Health Services Research and Technology Assessment, University of Southern Denmark, Odense, Denmarkh Aldermoor Health Centre, University of Southampton, UK

KeywordsComplementary medicine · Economics · Effectiveness · Physician · Practitioner · Provision · Training

SummaryBackground: The demand for complementary and alter-native medicine (CAM) treatment in the European Union (EU) has led to an increase in the various CAM interven-tions available to the public. Our aim was to describe the CAM services available from both registered medical practitioners and registered non-medical practitioners. Methods: Our literature search comprised a PubMed search of any scientific publications, secondary refer-ences and so-called grey literature, a search of govern-ment websites and websites of CAM organisations to collect data in a systematic manner, and personal com-munications, e.g., via e-mail contact. Due to the different reliability of data sources, a classification was developed and implemented. This weighted database was con-densed into tables and maps to display the provision of CAM disciplines by country, showing the distribution of CAM providers across countries. Results: Approximately 305,000 registered CAM providers can be identified in the EU (~160,000 non-medical and ~145,000 medical practitioners). Acupuncture (n = 96,380) is the most avail-able therapeutic method for both medical (80,000) and non-medical (16,380) practitioners, followed by home-opathy (45,000 medical and 5,800 non-medical practi-

tioners). Herbal medicine (29,000 practitioners) and re-flexology (24,600 practitioners) are mainly provided by non-medical practitioners. Naturopathy (22,300) is domi-nated by 15,000 (mostly German) doctors. Anthropo-sophic medicine (4,500) and neural therapy (1,500) are practised by doctors only. Conclusion: CAM provision in the EU is maintained by approximately 305,000 regis-tered medical doctors and non-medical practitioners, with a huge variability in its national regulatory manage-ment, which makes any direct comparison across the EU almost impossible. Harmonisation of legal status, teach-ing and certification of expertise for therapists would be of enormous value and should be developed.

Introduction

Complementary and alternative medicine (CAM) is a develop-ing area associated with much conflicting debate. It appears that CAM services are in great demand by patients. Life-time CAM use prevalence rates of between 3 and 25% are reported internationally [1, 2]. CAM use has been documented across Europe for the UK, Germany and Italy and is used by between 10 and 70% of the population [3–8]. However, in practice, there is a varying provision of CAM within the European Union (EU). This review covers the providers’ perspective and

Reflexology Provision by MD and Non-Medical Practitioners per 100'000 Inhabitants (EU 27+12)


Shiatsu Provision by MD and Non-Medical Practitioners per 100'000 Inhabitants (EU 27+12)


CAMbrella – In-depth Reports

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Omeopati ROSSI E. Registro degli Osteopati d'Italia ROSSI P. Università di Milano-Bicocca SIRONI V Università di Milano-Bicocca STREPPARAVA M. G. Università di Milano-Bicocca TOGNETTI M. Università di Milano-Bicocca TOMELLERI S. Università di Bergamo TOSTO C. Scuola Ayurvedic Point Milano VINTANI P. FederFarma WILLIAMS J.G. Associazione Italiana Chiropratici

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